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What is a Urethrotomy and What Do You Need to Know?

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urethrotome

A urethrotomy is also known as a direct vision urethrotomy, which is a surgical procedure used to treat urethral stricture disease. Urethrotomy is only performed on males, as a urethral stricture on women is extremely rare. A urethrotomy is an outpatient surgery that utilizes a urethrotome and a surgical knife is passed through a cystoscope to widen a narrow urethra.

Purpose

Some of the most common symptoms that may lead to a urethrotomy include pain when urinating, urinary tract infections, blood in the urine, and an inability to completely empty the bladder. All of these symptoms are good indicators of a narrowing in the urethra—the tube that expels urine from the bladder.

When these symptoms are noticed, the next step is to determine if the cause is urethral stricture disease. This can be diagnosed with a few simple procedures:

  • Physical examination
  • Urethral x-ray or ultrasound
  • Retrograde urethrogram
  • Urethroscopy
  • Cystoscopy

Risks

Unfortunately, there is not a high long-term success rate when it comes to urethrotomy. Many people who have one will require multiple subsequent surgeries, as there is a heightened risk of urethral stricture reoccuring. Studies have found that in the short term (less than six months following surgery) the success rate is around 70-80 percent. This number will decrease as individuals reach the one-year mark and subsequent years to follow.

Alternative Procedures

There are a few alternative procedures available. These alternative procedures include dilation and urethroplasty. Dilation is the practice of inserting thin rods into the urethra to increase the size and stretch out the stricture, ultimately widening the narrow opening. Urethroplasty is the reconstruction or replacement of the narrowed urethra via open surgery. The treatment your doctor recommends will widely be dependent upon the severity of your urethral stricture, as well as the success of previous procedures you have undergone in the past.

Prior to Surgery

Before undergoing surgery, your doctor will likely order an imaging test, along with cystoscopy to determine the length and severity of the stricture. Additionally, many doctors will order blood tests to check your overall health.

A urine sample will be collected and analyzed to determine if there are bacteria in the urine. Depending on your age and any other pre-existing heart conditions, your doctor may order a heart electrocardiogram.

Prior to undergoing surgery, you’ll be asked to discuss your medical history with your doctor. During this time, they will also discuss how the surgery will be performed and any associated risks. You’ll need to be prepared to fully discuss all medications and drugs that you are currently taking.

How to Prepare for Surgery

Because general anesthesia will be used for the procedure, you’ll be asked to refrain from eating and drinking prior to your procedure. Specific times and instructions will be provided to you by your doctor prior to surgery. Be sure to clarify with your doctor if/how you should take daily medications. The procedure should last approximately thirty minutes.

What to Bring With You

Preparing for a urethrotomy is similar to many other procedures, with a few specifics that will make your trip back home more enjoyable. Here are a few recommendations for the day of your procedure:

  • Bring loose-fitting underwear as you’ll most likely go home with a catheter
  • Consider bringing dark colored underwear instead of lightly colored ones that may exaggerate the look of any post-operative bleeding
  • If possible, bring a lean meal that you can eat following the surgery
  • Bring a case for glasses or hearing aids as you won’t be able to have them with you in the operating room

Following Surgery

Most individuals are able to return home the same day following surgery, although this will be dependent upon each individual’s unique circumstances. Because general anesthesia is necessary, most hospitals require you have another adult drive you home and observe you the following day. Prior to leaving the facility, it is recommended that you inform your doctor or attending nurse about any pain or discomfort you may be experiencing so that they can implement the most effective and suitable pain relief system. It is not uncommon to experience some discomfort after surgery along with a burning sensation in your urethra and a strong urge to pee.

Possible Complications

As with all surgical procedures, there is the possibility of complications. Some of the most common that are associated with a urethrotomy include:

  • Urethral Pain: a burning sensation or discomfort when urinating for a few days post-surgery
  • Bleeding: It is common for some blood to be passed in your urine. This should resolve itself within a week following surgery. If it continues to persist or you begin to see clots, report it to your doctor.
  • Infection: If you suspect you are experiencing a urinary tract infection following your surgery, you should immediately report it to your doctor. Signs of an infection include fevers and chills.
  • Recurrence of Stricture: Over time, it is possible that your urethra will narrow and develop a stricture again. After further consultation with your doctor, it may be advised that you undergo another similar surgery or urethroplasty.

When performed by a reputable doctor who has experience using a urethrotome, the results of this common procedure can drastically improve your quality of life.