Urology: Foley Catheter and Urethral Stenosis

Urology and Gynecology

• Foley Catheter is usually left in place for 48-72 hours to prevent urinary retention and avoid stenosis.
• Follow-up requires observing for development of urethral stenosis and recurrence.

Female Reproductive System

• The vestibule has six openings: two Skene's glands, two Bartholin's glands, vaginal introitus, urethral opening, and hymen.
• Caruncle myrtiformes are remnants of the adult female.
• Periurethral/Skene's glands and Vulvovaginal/Bartholin's glands are glandular structures.

Hormones

• Progesterone: critical mitogen, responsible for growth control, and maintains progesterone receptors.
• Estrogen: upregulates and maintains progesterone receptors, permits cellular proliferation, ECM accumulation, and cellular hypertrophy.

Myoma

• Characterized by extensive coagulative necrosis, carneous or red degeneration, and can cause severe pain and peritoneal irritation.
• Occurs in 5-10% of pregnant women, especially in those with a history of leiomyoma.
• Can be treated with GnRH agonists to shrink the myoma to 40-50% before surgery.

Cervical Stenosis

• Most often affects the internal os.
• Can be congenital or acquired, often seen in patients with a history of cervical biopsy, LEEP, or cone biopsy.
• Treatment involves dilation of the cervix.

Endometrial Polyp

• Localized overgrowth of endometrial glands and stroma that project beyond the endometrial surface.
• Soft and pliable, single or multiple, ranging from a few mm to several cm, and may be broad-based or have a slender pedicle.
• Associated with endometrial hyperplasia and unopposed estrogen.
• Incidence: more common in women aged 40-49 years old.
• Malignancy is related to the patient's age and is often of a low stage and grade.

Cervical Laceration

• Presents with vaginal bleeding, dysuria, urgency, obstruction, and dyspareunia
• Diagnosis through speculum, pelvic examination, and biopsy
• Management: hemostasis and ligation of bleeders, GnRH agonists, excision, or hysterectomy depending on reproductive status

Hemostasis and Ligation of Bleeders

• Major arterial supply to the cervix is located on the lateral cervical walls at the 3 and 9 o'clock positions
• Deep figure-of-eight suture through the vaginal mucosa and cervical stroma at 3 and 9 o'clock helps reduce blood loss during procedures like cone biopsy

Cervical Polyps

• Most common benign neoplastic growths of the cervix (4% of gynecologic patients)
• Endocervical polyps are most common in multiparous women in their 40's and 50's
• Etiopathogenesis: abnormal focal responsiveness (hyperplasia and proliferation) to hormonal stimulation or local inflammation
• Characteristics: fragile, bleed easily when touched, usually asymptomatic, but may present with abnormal bleeding
• Diagnosis: speculum examination and biopsy
• 6 subtypes: adenomatous (80%), cystic, fibrous, and others

Cervical Stenosis

• Causes: operative, fragile, and bleed easily when touched
• May present with abnormal bleeding: postcoital bleeding, menorrhagia, postmenopausal bleeding
• Ulceration is rare (less than 1 in 200)

Nabothian Cyst

• A small mucous polyp at the external os, typically cherry red
• May be diagnosed through speculum examination and can be confirmed through visualization