ICD-10: N35.113

The ICD-10 code N35.113 refers to a specific medical condition known as "Postinfective membranous urethral stricture, not elsewhere classified, male." This code is part of the broader category of urethral strictures, which are characterized by a narrowing of the urethra that can impede the flow of urine. Below is a detailed clinical description and relevant information regarding this condition.

Clinical Description

Definition

A postinfective membranous urethral stricture is a type of urethral stricture that occurs as a result of an infection. This condition specifically affects the membranous portion of the urethra, which is the segment located between the prostate and the bulb of the penis. The stricture is classified as "not elsewhere classified" because it does not fit into other specific categories of urethral strictures defined in the ICD-10 coding system.

Etiology

The primary cause of postinfective membranous urethral stricture is often related to previous infections, such as sexually transmitted infections (STIs) or urinary tract infections (UTIs), which can lead to inflammation and scarring of the urethra. Other potential causes may include trauma, surgical interventions, or inflammatory conditions affecting the urethra.

Symptoms

Patients with this condition may experience a variety of symptoms, including:
- Dysuria: Painful urination.
- Urinary frequency: Increased need to urinate.
- Urinary urgency: A sudden, compelling urge to urinate.
- Weak urine stream: Difficulty in initiating urination or a reduced flow of urine.
- Post-void dribbling: Leakage of urine after urination has completed.

Diagnosis

Diagnosis typically involves a combination of patient history, physical examination, and diagnostic tests. Common diagnostic procedures include:
- Urethroscopy: A procedure that allows direct visualization of the urethra using a thin, flexible tube with a camera.
- Urodynamic studies: Tests that measure how well the bladder and urethra store and release urine.
- Imaging studies: Such as ultrasound or MRI, to assess the anatomy of the urethra and surrounding structures.

Treatment

Treatment options for postinfective membranous urethral stricture may include:
- Dilation: A procedure to widen the narrowed area of the urethra.
- Urethrotomy: Surgical incision of the stricture to relieve obstruction.
- Urethroplasty: A more extensive surgical procedure that involves removing the stricture and reconstructing the urethra.
- Catheterization: Temporary measures to relieve urinary retention.

Conclusion

ICD-10 code N35.113 is crucial for accurately documenting and coding cases of postinfective membranous urethral stricture in males. Understanding the clinical implications, symptoms, diagnostic methods, and treatment options associated with this condition is essential for healthcare providers to ensure appropriate management and care for affected patients. Proper coding not only aids in clinical documentation but also plays a significant role in healthcare billing and insurance processes.

Postinfective membranous urethral stricture, classified under ICD-10 code N35.113, is a condition characterized by the narrowing of the urethra due to scarring or fibrosis following an infection. This condition primarily affects males and can lead to significant urinary complications. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this diagnosis.

Clinical Presentation

Definition and Etiology

Postinfective membranous urethral stricture occurs when the urethra, particularly the membranous segment, becomes narrowed due to scarring that follows an infectious process. Common infections that can lead to this condition include sexually transmitted infections (STIs) such as gonorrhea and chlamydia, as well as urinary tract infections (UTIs) that may cause inflammation and subsequent scarring of the urethra[1].

Patient Characteristics

• Demographics: This condition predominantly affects adult males, particularly those in their 20s to 50s, who may have a history of STIs or recurrent UTIs[2].
• Risk Factors: Risk factors include a history of urethral trauma, previous urethral surgeries, and chronic inflammatory conditions. Additionally, individuals with a history of catheterization or those with a compromised immune system may be at higher risk[3].

Signs and Symptoms

Common Symptoms

Patients with postinfective membranous urethral stricture may present with a variety of urinary symptoms, including:

• Dysuria: Painful urination is often reported, which may be due to inflammation or irritation of the urethra[4].
• Urinary Frequency and Urgency: Patients may experience an increased need to urinate, often accompanied by a sense of urgency[5].
• Weak Urinary Stream: A notable decrease in the force of the urinary stream is common, which can be indicative of a stricture[6].
• Straining to Urinate: Patients may find themselves needing to exert more effort to initiate urination, which can be frustrating and uncomfortable[7].
• Post-void Dribbling: This symptom involves the involuntary leakage of urine after the main stream has stopped, often due to incomplete bladder emptying[8].

Physical Examination Findings

During a physical examination, healthcare providers may note:

• Tenderness: There may be tenderness in the lower abdomen or perineal area, particularly if there is associated inflammation[9].
• Palpable Bladder: In cases of significant obstruction, the bladder may be distended and palpable above the pubic symphysis[10].

Diagnostic Considerations

Diagnostic Tests

To confirm the diagnosis of postinfective membranous urethral stricture, several diagnostic tests may be employed:

• Urethroscopy: This procedure allows direct visualization of the urethra and can help identify the location and extent of the stricture[11].
• Uroflowmetry: This test measures the flow rate of urine and can help assess the severity of the obstruction[12].
• Imaging Studies: Ultrasound or MRI may be used to evaluate the urinary tract and identify any associated abnormalities[13].

Conclusion

Postinfective membranous urethral stricture is a significant condition that can lead to various urinary symptoms and complications in males. Understanding the clinical presentation, signs, symptoms, and patient characteristics is crucial for timely diagnosis and management. Early intervention can help alleviate symptoms and prevent further complications, emphasizing the importance of recognizing this condition in clinical practice. If you suspect a patient may have this condition, a thorough evaluation and appropriate diagnostic testing are essential for effective treatment planning.

ICD-10 code N35.113 refers specifically to "Postinfective membranous urethral stricture, not elsewhere classified, male." This code is part of the broader classification of urethral strictures, which are conditions characterized by the narrowing of the urethra, often resulting from infection, injury, or other medical conditions. Below are alternative names and related terms associated with this specific ICD-10 code.

Alternative Names

1. Postinfective Urethral Stricture: This term emphasizes the stricture's origin following an infection.
2. Membranous Urethral Stricture: This highlights the specific anatomical location of the stricture within the urethra.
3. Male Urethral Stricture: A general term that indicates the condition is specific to males, which is relevant for this code.

Related Terms

1. Urethral Stricture Disease: A broader term encompassing various types of urethral strictures, including those caused by infections.
2. Urethral Obstruction: This term can be used to describe the functional impact of a stricture, as it leads to obstruction of urine flow.
3. Postinfective Complications: This term refers to complications that arise following an infection, which can include strictures.
4. Stricture Urethritis: While not a direct synonym, this term relates to inflammation of the urethra that can lead to stricture formation.
5. Membranous Urethra: Referring to the specific part of the urethra affected by the stricture, which is important for understanding the anatomical context.

Clinical Context

Understanding these alternative names and related terms is crucial for healthcare professionals when diagnosing and coding conditions accurately. The specificity of the ICD-10 code N35.113 helps in identifying the nature of the stricture and its underlying causes, which can influence treatment decisions and patient management strategies.

In summary, the ICD-10 code N35.113 is associated with various alternative names and related terms that reflect its clinical significance and anatomical specificity. Recognizing these terms can enhance communication among healthcare providers and improve patient care outcomes.

The diagnosis of ICD-10 code N35.113, which refers to "Postinfective membranous urethral stricture, not elsewhere classified, male," involves specific clinical criteria and considerations. Below is a detailed overview of the diagnostic criteria and relevant information regarding this condition.

Understanding Urethral Strictures

Urethral strictures are narrowings of the urethra that can result from various causes, including infections, trauma, or surgical interventions. In the case of N35.113, the stricture is specifically postinfective, meaning it occurs as a complication following an infection.

Key Diagnostic Criteria

1. Clinical History:
   - A thorough patient history is essential, focusing on previous urinary tract infections (UTIs) or sexually transmitted infections (STIs) that may have led to the stricture.
   - Symptoms such as difficulty urinating, weak urine stream, or urinary retention should be documented.

2. Physical Examination:
   - A physical examination may reveal signs of urinary obstruction or other related complications.
   - Digital rectal examination (DRE) may be performed to assess the prostate and surrounding structures.

3. Urodynamic Studies:
   - Urodynamic testing can help evaluate the function of the bladder and urethra, providing insights into the severity of the obstruction caused by the stricture.

4. Imaging Studies:
   - Retrograde Urethrogram (RUG): This imaging technique is crucial for visualizing the urethra and identifying the location and length of the stricture.
   - Voiding Cystourethrogram (VCUG): This test assesses the bladder and urethra during urination, helping to confirm the diagnosis.

5. Cystoscopy:
   - A cystoscopy allows direct visualization of the urethra and bladder, enabling the physician to assess the stricture's characteristics and potentially perform interventions.

6. Exclusion of Other Causes:
   - It is important to rule out other potential causes of urethral obstruction, such as tumors or congenital abnormalities, to ensure accurate diagnosis.

Additional Considerations

• Infection History: The diagnosis of postinfective membranous urethral stricture specifically requires a documented history of infection that could lead to scarring and subsequent narrowing of the urethra.
• Patient Demographics: This condition is typically diagnosed in males, and understanding the patient's age and health history can provide context for the diagnosis.

Conclusion

Diagnosing N35.113 involves a comprehensive approach that includes patient history, physical examination, imaging studies, and possibly cystoscopy. The focus is on identifying a postinfective cause for the membranous urethral stricture, ensuring that other potential causes are ruled out. Proper diagnosis is crucial for determining the appropriate management and treatment options for the patient.

Postinfective membranous urethral stricture, classified under ICD-10 code N35.113, refers to a narrowing of the urethra that occurs following an infection, specifically affecting the membranous segment of the urethra in males. This condition can lead to significant urinary symptoms and complications if not addressed appropriately. Below, we explore the standard treatment approaches for this condition.

Understanding Urethral Strictures

Urethral strictures can arise from various causes, including trauma, infection, or inflammation. In the case of postinfective strictures, the underlying infection can lead to scarring and narrowing of the urethra, which may result in obstructive urinary symptoms such as difficulty urinating, weak urine stream, and urinary retention[1].

Standard Treatment Approaches

1. Conservative Management

In mild cases, conservative management may be sufficient. This can include:

• Observation: Monitoring the condition without immediate intervention, especially if symptoms are mild.
• Urethral Dilation: A non-surgical procedure where a dilator is inserted into the urethra to widen the stricture. This can provide temporary relief but may need to be repeated over time[2].

2. Surgical Interventions

For more severe cases or when conservative measures fail, surgical options are typically considered:

• Urethrotomy: This procedure involves making an incision in the stricture to relieve the obstruction. It is often performed under local or general anesthesia and can provide immediate relief of symptoms[3].

• Urethroplasty: This is a more definitive surgical approach where the narrowed segment of the urethra is excised and reconstructed. Urethroplasty is considered the gold standard for treating urethral strictures, particularly in cases where the stricture is long or recurrent[4].

3. Postoperative Care and Follow-Up

Post-surgical care is crucial for recovery and includes:

• Catheterization: A urinary catheter may be placed postoperatively to allow for healing and to ensure proper urine drainage.
• Follow-Up Appointments: Regular follow-ups are necessary to monitor for recurrence of the stricture and to assess urinary function. Urodynamic studies may be performed to evaluate bladder function and urethral patency[5].

4. Adjunctive Therapies

In some cases, adjunctive therapies may be utilized to enhance treatment outcomes:

• Antibiotics: If there is an ongoing infection, appropriate antibiotic therapy is essential to manage the infection and prevent further complications[6].
• Steroid Injections: In certain cases, corticosteroid injections may be used to reduce inflammation and scarring in the urethra, although this is less common[7].

Conclusion

The management of postinfective membranous urethral stricture (ICD-10 code N35.113) involves a combination of conservative and surgical approaches tailored to the severity of the condition and the patient's overall health. Urethral dilation and surgical interventions like urethrotomy and urethroplasty are the mainstays of treatment, with careful postoperative management to ensure optimal recovery. Regular follow-up is essential to monitor for recurrence and to maintain urinary function. If you suspect you have this condition, consulting a urologist for a comprehensive evaluation and treatment plan is advisable.

References

1. Urethral Stricture - AUA Guideline.
2. Clinical Diagnostic Laboratory Services.
3. ICD-10 NCD Manual.
4. Medicare National Coverage Determinations (NCD).
5. ICD-10 International statistical classification of diseases.
6. ICD 10 NCD Manual.
7. 2019-03-06 ICD-10 NCD Manual.