Urethrotomy - Procedure and Complications

What Is the Urethrotomy Procedure?

Urethrotomy, also known as direct vision internal urethrotomy, is a surgical procedure done to manage the problem of urethral stricture or the narrowing of the urethra. In simple terms, the urethral stricture is nothing but the narrowing of the urethra due to injury or the formation of scar tissues. It is considered an outpatient procedure because it is mainly done in the hospital using a urethrotomy or a surgical knife. The surgical instruments are inserted through a cystoscope to widen the narrowed urethra. Urethrotomy is commonly done in males, as females rarely experience urethral strictures.

What Is Urethral Stricture?

The urethral structure is a common urologic condition in which the urethra becomes narrow due to the formation of scar tissues. A stricture mainly restricts the drainage of the urinary bladder and can cause various medical conditions, including inflammation and infection of the urinary tract. Some of the symptoms of urethral stricture are listed below:

• Reduced urine stream.

• Difficulty in emptying the urinary bladder.

• Inability to urinate completely.

• Pain while passing urine.

• Increased urine frequency.

• A strong and persistent urge to pass urine.

• Urinary tract infections.

Why Is a Urethrotomy Done?

Urethrotomy is usually done when the patient experiences symptoms, including pain while passing urine, blood in the urine or hematuria, bladder fullness, and spraying urine. These symptoms typically suggest that the person is suffering from urethral narrowing of urethral strictures. However, the doctor might recommend the following tests to confirm the diagnosis:

1. Physical Examination - The doctor might examine the patient to look for pain, tenderness, and other symptoms.

2. Ultrasound - The doctor might do an ultrasound or an X-ray to look for abnormalities in the internal urologic organs. These are useful diagnostic aid in detecting urinary tract problems.

3. Ureteroscopy - It is a procedure in which a tube known as the urethroscope is inserted into the bladder through the urethra to visualize the urinary tract anomalies. Urethroscopy not only helps diagnose urethral strictures but also manages them simultaneously.

4. Cystoscopy - It is similar to a ureteroscopy, the only difference being the cystoscope is inserted into the bladder and the urinary tract.

What Happens Before Urethrotomy Surgery?

• The patient does not have to make any special preparations for the procedure.

• However, the doctor might order the patient to undergo certain imaging tests, including cystoscopy, to check the length and severity of the urethral stricture.

• The doctor might recommend blood tests to ensure that the patient is in good health and clinically fit for the surgery.

• The patient might be asked to provide his urine sample before the procedure to ensure it is free from bacteria.

• Elderly patients and people suffering from cardiac diseases might have to undergo electrocardiograms to ensure that their heart is healthy enough to pump blood.

• The patient must explain his medical history to the doctor and understand the procedure completely before undergoing it.

• The patient must inform the doctor about the herbal supplements and other over-the-counter or prescription medications he is taking.

• If the patient is taking anticoagulants, he might need to stop taking the drug before the surgery as the patient might have severe bleeding during and after the surgery.

• The patient must carefully read and sign the consent form before opting for the procedure.

What Happens During the Urethrotomy Procedure?

Before the procedure, the patient will be asked to fast overnight. He can only consume clear fluids or water two to three hours before the surgery. The patient must follow all the instructions provided by the doctor. If the doctor has recommended any medications, the patient must take them before the surgery. The following happens during the procedure:

• The patient will be administered antibiotics before the procedure. In order to eliminate the risk of infections.

• The patient will be asked to change into a hospital gown.

• The patient will be asked to lie down on the cystoscopy table in a dorsal lithotomy position. In this position, the knees are raised with the thighs apart.

• Once the patient is asleep under the influence of general anesthesia, a urethrotome or a cystoscope with a surgical knife will be inserted into his urethra.

• The doctor will cut and open the strictured area to reassess it. If the area can be easily opened, no further incisions are made.

• The urinary bladder will be emptied and filled with irrigation fluid.

• Finally, the doctor will insert a catheter into the area to drain the remaining irrigating fluid.

• The procedure gets completed in 30 minutes. Finally, the patient will be shifted to the recovery room.

What Happens After the Procedure?

After the patient is shifted to the recovery room, his condition will be constantly monitored. The doctor will check the patient’s vitals, including blood pressure, pulse, temperature, and respiratory rate. He will also test the intensity of pain and the frequency of passing urine. An intravenous line will be attached to the patient’s arm to administer painkillers, food, and other medications. Sometimes, the patient is discharged the same day or might be asked to stay in the hospital for one more day.

How Should the Patient Take Care After the Surgery?

The patient might feel slightly uncomfortable after the surgery because of the catheter. The wound must be kept open and dry to allow the healing to progress naturally. The patient must keep in mind the following things after the surgery:

• After the surgery, the doctor will provide the necessary instructions for the self-catheterization procedure.

• The patient must take all the painkillers and other antibiotics the doctor prescribes regularly.

• Avoid moving around, exercise, and do other physical activities for a few weeks after the procedure.

• The patient must not get involved in sexual intercourse for a few weeks.

• Consume lots of fluids, have a healthy and fiber-rich diet and do not strain during bowel movements.

What Are the Risks or Complications of Urethrotomy?

The patient might have certain complications during the urethrotomy procedure. Some of these are listed below:

1. The patient might experience urethral pain and a burning sensation for a few days after the procedure.

2. The patient might notice blood in his urine for one week. However, if the condition persists for more than a week, he must consult the doctor immediately.

3. The patient might experience fever and chills due to the urinary tract infection after the surgery.

4. It is highly possible that the urethral stricture might recur after the surgery.

Conclusion:

Urethrotomy is a procedure wherein the patient’s urethra is widened to resolve the problem of urethral strictures. The patients experience a lot of difficulty due to the narrowing of the urethra. They might find it difficult to urinate, resulting in pain and pressure in the abdomen. However, the patient need not be worried. He must immediately consult his doctor to learn more about the urethrotomy procedure.