Introduction:
The urethra is a small tube-like structure connected to the urinary bladder and helps drain urine from the body. Under normal circumstances, urine is stored in the bladder, and at the right time, the brain sends a signal to contract the bladder muscle and relax the sphincter muscles, thus allowing the urine to drain out of the body. However, a constriction in the urethra makes bladder emptying difficult. Difficulty in urine voiding includes difficulty in starting or maintaining the urine flow or the requirement to push or strain to empty the bladder. This dysfunction in voiding leads to incomplete bladder emptying. The exact reason for voiding dysfunction is not understood completely. However, it might result from a previous incontinence surgery or advanced bladder prolapse. Such dysfunction is treated by a procedure that stretches and dilates the urethra, known as urethral dilation. It is often indicated in men than in women.
What Are the Indications for Urethral Dilation?
Urethral dilation is carried out in the case of:
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Urethral Stricture - A urethral stricture is the scarring and narrowing of the urethra. A constriction hinders the urinary bladder's urine flow, causing various medical problems in the urinary tract, such as inflammation and infection.
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Meatal Stenosis - Meatal stenosis is a condition in which the opening at the end of the penis becomes narrower than usual. Individuals with this condition experience pain and burning during urination, a narrow or fast urine flow, difficulty directing the urine flow, and frequent urination. This condition is usually present since birth and is commonly caused by circumcision.
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Occasionally, urethral dilation is done before passing a large instrument, such as a lithotrite or resectoscope, through the urethra.
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Urethral dilation in females has a healing effect in non-specific trigonitis (inflammation of the lower part of the bladder near the urethra) and urethral syndrome (lower urinary tract infection when the urethra becomes infected).
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Urethral dilation is sometimes done to calibrate the urethra.
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Urethral dilation is done to delineate the urethra just before a diverting urethrotomy (urethral surgery).
What Are the Contraindications for Urethral Dilation?
Urethral dilation is contraindicated in the case of -
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Severe stricture disease.
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Bleeding.
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Untreated infection.
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Repeated dilation is contraindicated in kids due to the need for general anesthesia.
What Happens Before the Urethral Dilation Surgery?
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Before the procedure is carried out, a careful association of the detailed history with obstructive symptoms and the individual's age is evaluated to establish the requirement for dilation.
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Urethrogram - A urethrogram is the examination of the urethra with the help of X-rays. It is carried out to detect the presence of a stricture, and its characteristics, to decide the suitable mode of treatment.
What Happens During the Urethral Dilation Surgery?
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The urologist reviews the history and medications of the individual.
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The surgical procedure is well discussed with the individual, and consent is obtained.
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An anesthetist will discuss the options of general or spinal anesthesia.
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The individual might be provided with a pair of TED (thrombo-embolus deterrent) stockings to wear and injected with heparin to make the blood thin. TED stockings and Heparin prevent the formation of blood clots.
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The individual is asked to get into a comfortable position, such as lying on the bed, sitting on the toilet seat, or standing over the toilet.
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The tip of the penis is washed and cleaned thoroughly.
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A clean catheter tip is dipped or rolled into a lubricant.
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The penis is grasped and pulled out gently at a right angle from the body.
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The catheter is then inserted and slides into the urethral opening without forcing until urine starts to drain.
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Once the urine starts to drain, the catheter is inserted around two to five cm.
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The catheter is slowly withdrawn when the urine stops flowing.
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The catheter is then cleaned by rinsing it under clean running water, the tip upwards.
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The catheter is dried and stored in a clean, sealed container till subsequent use.
What Are the Complications of the Urethral Dilation Procedure?
Urethral dilation is a safe procedure, but some risks and complications are associated with it, as with any other procedure. They are -
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Bleeding - Bleeding could be due to a simple tear at the stricture area, rapid dilation, or actual penetration of the urethra or prostate. At times, severe injury to the prostate might occur.
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Infection - Temporary bacteremia (bacterial infection of the blood) usually occurs due to the introduction of a large number of bacteria into the bloodstream, releasing their toxins, which might lead to shock or death.
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Pain or burning while passing urine.
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Adverse Reaction to Anesthesia - Sudden absorption of large amounts of local anesthesia could lead to drug-related issues.
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Epididymitis - This is an inflammation of the small, coiled tubes at the back side of the testicle. Epididymitis can occur as a result of infection.
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Repetition of the procedure due to recurrent stricture formation
What Happens After the Urethral Dilation Procedure?
After the urethral dilation procedure, the patient is kept under observation for half an hour to one hour, then discharged. In case of excess bleeding, injury to the urethra, or the presence of pus on the dilator, the patient is admitted overnight. Excess bleeding is controlled by applying pressure on the perineum (the space between the anus and scrotum), followed by retention after discharge. Such patients are catheterized for a couple of days.
How Frequently Should Urethral Dilation Be Done?
The urethral dilation should be repeated at two to six weeks and then at the interval of eight to 12 weeks a year. After this, dilation is advised every six months. Patients undergoing surgery under local anesthesia do not require admission, whereas those under general anesthesia require hospital admission. Dilation can be performed in the doctor's chamber, but complicated cases should be transferred to a hospital ward.
Conclusion:
Urethral dilation is a procedure that dilates the urethra in case of urethral stricture. The main indication is a male stricture. It is not a definitive treatment for male stricture, as the stricture returns after dilation. It is no longer recommended for women. The patient usually requires a period of catheterization after the dilatation procedure. There are a couple of risks involved with the procedure. The prognosis, however, is good.
