Urology

Urethrotomy Treatment

Urethrotomy

Urethrotomy is a surgical procedure used for treating urethral stricture disease. It is an ambulatory surgery that involves the usage of a urethrotome or a surgical knife passed through a cystoscope for widening the narrowed urethra. Urethrotomy is usually done only on the men, as urethral strictures in the women are quite rare.

What is Urethrotomy?

Urethrotomy is a surgical procedure used for treating urethral stricture disease. It is an ambulatory surgery that involves the usage of a urethrotome or a surgical knife passed through a cystoscope for widening the narrowed urethra. Urethrotomy is usually done only on the men, as urethral strictures in the women are quite rare.

A urethrotomy is an operation which involves cuts on the urethra, especially for relieving the stricture. It is generally done in the outpatient setting, with the patient being discharged from the hospital within six hours from the procedure's inception.

Why Urethrotomy is required?

If a person complains about symptoms like pain when urinating, blood in urine, urinary tract infections, and inability to fully empty their bladder, the doctor may suspect that there’s a narrowing in the person’s urethra.

The next step will be to confirm if the person has urethral stricture disease or not. Urethral stricture disease can be diagnosed with the help of:

  • Simple physical examination
  • Urethral X-ray or ultrasound
  • Retrograde urethrogram
  • Urethroscopy
  • Cystoscopy

It is only after this diagnosis has been made that the doctor will suggest the patients undergo a urethrotomy.

What to Expect from the Surgery?Page Image

Prior to Procedure:

The patient’s doctor may perform the following:

  • The doctor will conduct a physical exam and ask the patients about their medical history
  • Order imaging, urine, and blood tests
  • The doctors talk about the anesthesia which is to be used and its potential risks
  • The patients must talk to their doctor about their medications. The patients may be asked to stop taking some medications up to 10 days prior to their surgery.

In the days leading up to the surgery:

  • The patients must take a shower before the surgery as directed by the doctors
  • The patients must arrange a ride for their home from the hospital.
  • The patients must not take anything by mouth starting 8 hours prior to their surgery. The patients must ask the doctor how they should take their regular medications on the morning of their surgery.

Anesthesia

  • Spinal or general anesthesia will be used. It will use in blocking any pain and keep the patients sedated or asleep during the surgery.

Description of the Procedure

After the patients are asleep, a special tube known as cystoscope will be placed in the patient’s urethra for locating the stricture. Next, a special tool will be placed through the cystoscope and will be used for cutting away the scar tissue inside the patient’s urethra for making it wider. The scar tissue may be removed either by cutting or by the use of a heat source or a laser. After the tissues are being removed, the bladder area and urethra will be examined. A catheter (it is a plastic tube placed through the urethra into the bladder) may be placed once the procedure is being completed.

How long will the surgery take place?

The surgery usually requires about 30 minutes. Anesthesia prevents pain during the procedure. The patients must ask their doctor about medication, which helps them with their pain. The patients will be able to go home the same day in almost every case.

How soon will I recover?

The catheter will be put in place during the surgery and is more likely to remain for some days. The primary purpose of the catheter is to keep the space open and let it heal. In the meantime, the patients can expect:

  • The doctor will tell the patients on self-catheterization or how to manage the one that has been already placed. The patient’s doctor will also tell them when to return to the hospital for removing.
  • The patient’s doctor may also prescribe antibiotics for their post-operation for reducing their chances of getting an infection. The patients should maintain good hygiene for reducing the risks.
  • The patients will be able to move around and are more likely to return to their work after some days.
  • The patients must refrain themselves from sexual intercourse for a couple of weeks after the surgery has been performed. The doctors will tell the patients how long they must refrain themselves from any sexual intercourse.
  • The patients must avoid intense exercise and strenuous activity until their doctor has given them the go-ahead.
  • It is vital that the patients must not strain during bowel movements.

What are the risks involved?

The long-term success rate of urethrotomy is very low and many patients who have undergone the surgery will still have to undergo subsequent surgeries as there is a huge risk that the urethral stricture will reoccur after the passage of time.

There are certain complications that can occur after the patients have undergone a urethrotomy. Some of the most common ones are as follows:

Urethral pain: It is normal to feel a burning sensation or discomfort when the patients are urinating for a few days post-surgery.

Bleeding: It is normal that the patients will pass out a bit of blood with their urine. This condition should resolve itself within a week or so after their surgery has been concluded. If this condition persists or the patients start to see clots, they must report it to their doctor.

Infection: If the patients suspect they have a urinary tract infection after their surgery, they must immediately report it to their doctor.

Recurrence of stricture: There is a huge possibility that an individual’s urethra will narrow or a stricture will be developed again.

Various factors that may increase the risk of complications include the following:

  • Bleeding disorders or taking medications that reduce the blood clotting
  • Obesity
  • Smoking

Alternate Options for the Urethrotomy:

Alternative procedures to a urethrotomy are urethroplasty and dilation. Dilation involves the insertion of thin rods for increasing the size into the patient’s urethra for stretching out the stricture and widening the narrowing. Urethroplasty is the replacement or reconstruction of a narrowed urethra by the means of open surgery. What the doctor will suggest the patients undergo largely depends on the severity of their urethral stricture and also on the success.

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