102:) is a popular treatment for male urethral strictures. However, the performance characteristics are poor. Success is less than 9% for the first or subsequent urethrotomies. Most patients will be expected to experience failure with longer followup and the expected long-term success rate from any urethrotomy approach is 0%. Beginning in 2003, several urology residency programs in the northeastern section of the United States began advocating the use of urethrotomy as initial treatment in the young stricture patient, versus urethral dilatation. It is theorized that the one-to-two years of relief from stricture disease will allow the practitioner and the patient to plan the most effective treatment regimen without having the concern that undergoing multiple dilatations cloud the judgment of the patient. Furthermore, should
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occur. (Note: bleeding after a urethrotomy is expected and can last up to 48 hours.) Purchasing cheap black or dark grey undergarments can help with post-surgery anxiety as light-colored undergarments can make the bleeding appear worse than it actually is and the undergarments can be thrown out after use. Additionally, applying water-based lubricant to the catheter and allowing it to run down and coat the opening of the urethra will prevent the catheter from rubbing and irritating the urethral opening. Lastly, preparing lean meals before surgery such as grilled chicken or salad is a good idea to ease recovery for the 48 hours after surgery.
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to remain in place for up to ten minutes. The catheter is then carefully withdrawn and discarded, and the patient is then instructed to void as soon as possible (this helps to cleanse the urethra of any blood or water-based lubricant and lessen the possibility of infection). Although no formal studies have been conducted, there does appear to be an improvement in intervals between subsequent urethrotomies and an improvement in uroflowmetric data for most patients who have undergone this regimen.
259:, and locked into place by filling its balloon (positioned inside of the bladder near the urethral junction) with sterile water. The Foley catheter serves two purposes, first, it provides drainage of the urine produced in the kidneys, and secondly, it secures the incised areas, holding them open for three to seven days to permit thorough healing of the urethra. The catheter is then attached to a urinary catheter drainage system (large bag or leg bag) via clear polypropylene tubing.
247:). The urological surgeon will inject the anesthetic at the twelve o'clock, four o'clock, and eight o'clock positions at the face of the stricture using infiltrative technique, and ensuring that the entire length of the stricture has been medicated. The cystoscope (and injection system) will be withdrawn, and sufficient time will be allowed for the local anesthetic to take effect (usually five-to-ten minutes).
29:
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It has become common practice for urologists to prescribe self-catheterization at weekly intervals for the post-urethrotomy patient. After voiding, and using sterile technique, a lubricated Foley catheter is passed into the urethra, through the surgically modified area, into the bladder and allowed
250:
At this time a rigid urethrotome or a flexible cystoscope/urethrotome combination will be inserted and guided to the face of the stricture and a small blade towards the tip of the instrument will be deployed using a trigger mechanism to cut the stricture at locations determined by the surgeon. Upon
345:
Comparing the two surgical procedures, a UK trial found that both urethrotomy and urethroplasty are effective in treating urethral stricture in the bulbar region. At the same time the more invasive urethroplasty had longer-lasting benefit and was associated with fewer re-interventions. The results
296:
The surgeon will remove the catheter three to seven days after the surgery is completed. A baseline uroflowmetric study will be performed, and the patient will be instructed to return in thirty days for a follow-up evaluation. This evaluation will include another uroflowmetric study and a complete
331:
Urethrotomy is a much simpler operation requiring much less recovery time and that open surgical excision of a simple, short stricture even if initially successful may still require the same repeated post operative self dilation that the simpler urethrotomy often requires. It may be that a longer
287:
A few steps can be taken before surgery to reduce the discomfort of recovery. It is suggested to wear loose fitting undergarments after the procedure as there is a chance of having a catheter after the procedure. Men's cotton boxers work well for both comfort and containing any bleeding that may
267:
Prior to discharge from the surgical facility, the patient will be instructed on proper care of the urinary drainage system, how to monitor for signs of infection, and the limitations of physical activity necessary for the safety of the patient, and the success of the procedure. A course of oral
581:
Goulao, Beatriz; Carnell, Sonya; Shen, Jing; MacLennan, Graeme; Norrie, John; Cook, Jonathan; McColl, Elaine; Breckons, Matt; Vale, Luke; Whybrow, Paul; Rapley, Tim; Forbes, Rebecca; Currer, Stephanie; Forrest, Mark; Wilkinson, Jennifer (13 September 2020).
239:, and a penile (crown) clamp is applied for at least five minutes, then removed immediately prior to the insertion of a cystoscope equipped with a transurethral injection system containing a local anesthetic (most often 2% (plain)
106:
be selected by the patient, minimal scar tissue will have developed at the site of the stricture in the urethrotomy patient, as opposed to the patient who had undergone the more conventional (dilatation) route.
324:
essentially concluded that there is a statistical correlation between the length of the stricture and the cost versus benefit ratio of subsequent urethrotomies performed prior to the performance of
91:. It is most often performed in the outpatient setting, with the patient (usually) being discharged from the hospital or surgery center within six hours from the procedure's inception.
584:"Surgical Treatment for Recurrent Bulbar Urethral Stricture: A Randomised Open-label Superiority Trial of Open Urethroplasty Versus Endoscopic Urethrotomy (the OPEN Trial)"
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The cost-effectiveness of the procedure has come into question. In the May, 2006 issue of "Urology", a study undertaken by the
Urology Department of the
188:, depending on the level of discomfort anticipated by the surgeon. In some cases, usually where longer strictures are present, a rapidly metabolized
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44:
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Many leading urologists in the United States consider urethrotomy to be (almost) totally ineffective at providing long-term resolution of
453:"Smith's Textbook of Endourology, By Arthur D. Smith, Gopal H. Badlani MD, Demetirus H. Bagley MD, Ralph V. Clayman, Steven G. Docimo MD"
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urinalysis. Follow-up visits are scheduled at six-month intervals, as determined by the practitioner responsible for the treatment plan.
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are carried out by the anesthesia practitioner until the patient is discharged post-operatively to the post-surgical recovery unit.
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medications may sometimes be prescribed, but are often not necessary because there is usually minimal discomfort post-procedure.
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complicated stricture may be better treated with an open procedure while the shorter simpler one with a urethrotomy.
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of the (now) patent urethral ends, or a grafting of similar tissue harvested from elsewhere on the patients body.
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496:"Cystoscopy and Optical Internal Urethrotomy Peri-Op Instructions: Urologic Surgical Associates of Delaware"
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534:"Cost-effectiveness of direct vision urethrotomy versus urethroplasty for short bulbar urethral strictures"
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Santucci R, Eisenberg L (May 2010). "Urethrotomy has a much lower success rate than previously reported".
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antibiotics or anti-infective agents will be prescribed. Additionally, a urinary analgesic such as
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medication at sometime prior to, or during the surgical preparation. This medication is usually a
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completion of the internal incision(s), the instrument is withdrawn and an appropriately sized
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will be the chosen adjunct to patient comfort, and the patient will have received intravenous
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633:"The standard for the management of male urethral strictures in the UK: a consensus document"
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517:"Long-term Follow up for Excision and Primary Anastomosis for Anterior Urethral Strictures"
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Genitourinary surgery, Gratia M. Nagle, R.N., B.S.N., James R. Bollinger, M.D. F.A.C.S.
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554:(Plain English summary). National Institute for Health and Care Research. 2020-12-18.
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will also be necessary if general anesthesia is administered). Constant monitoring of
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is cleansed with an appropriate surgical cleansing agent (scrub), usually containing
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Bugeja, Simon; Payne, Stephen R.; Eardley, Ian; Mundy, Anthony R. (18 June 2020).
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were integrated into the new UK guidelines on the treatment urethral narrowing by
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may be selected, as this allows for the immediate induction of short-term
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536:. University of Washington - Seattle, Department of Urology. 2006-08-17.
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disease, and advocate excision of the damaged area followed by either a
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255:will be inserted through the repair and into the
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146:medication is administered in conjunction with
115:Now the diagnosis has been confirmed by either
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177:practitioner may also choose to administer a
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328:in males suffering from bulbar strictures.
280:, and hyoscyamine sulfate will be offered.
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173:is employed. The urological surgeon or
231:A topical anesthetic, usually viscous
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682:The Center for Reconstructive Urology
417:Nagle, G.M.; Bollinger, J.R. (1997).
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722:Tests and procedures involving the
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100:Direct Visual Internal Urethrotomy
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292:Post surgical evaluation and care
94:Urethrotomy (also referred to as
1035:Extracorporeal shockwave therapy
123:, the patient is placed in the
83:which involves incision of the
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341:Urethrotomy vs. urethroplasty
135:, then surgically draped. An
87:, especially for relief of a
893:Artificial urinary sphincter
752:Percutaneous nephrolithotomy
600:10.1016/j.eururo.2020.06.003
898:Urethral bulking injections
637:Journal of Clinical Urology
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985:Voiding cystourethrography
393:10.1016/j.juro.2010.01.020
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928:Urinary tract ultrasound
649:10.1177/2051415820933504
322:University of Washington
1013:Urinary catheterization
970:Radioisotope renography
202:endotracheal intubation
16:Incision of the urethra
980:Retrograde urethrogram
784:Kidney transplantation
235:is instilled into the
850:Suprapubic cystostomy
421:Genitourinary Surgery
817:Ureterosigmoidostomy
315:surgical anastomosis
263:Post procedural care
560:10.3310/alert_43436
474:Mosby, 1997. 1997.
155:procedural sedation
990:Urodynamic testing
903:Cystourethrography
311:urethral stricture
243:, or 0.5% (plain)
214:cardiac monitoring
198:general anesthesia
125:lithotomy position
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1028:Laser lithotripsy
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305:Controversy
274:methanamine
245:bupivicaine
206:vital signs
148:intravenous
119:or a prior
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33:Urethrotome
22:Urethrotomy
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855:Cystoscopy
845:Cystectomy
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366:References
282:Palliative
208:including
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159:anxiolytic
140:antibiotic
127:, and the
117:cystoscopy
40:ICD-10-PCS
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933:Pyelogram
762:Endoscopy
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425:. Mosby.
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233:lidocaine
182:analgesic
171:midazolam
165:, often,
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81:operation
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190:hypnotic
184:such as
179:narcotic
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