Urethrotomy

Urethrotomy is a surgical procedure used to treat urethral strictures, which are narrowings or blockages of the urethra, the tube that carries urine from the bladder out of the body.

Indications for Urethrotomy

• Treatment of urethral strictures caused by injury, infection, or inflammation
• Relief of urinary obstruction and improvement of urine flow
• Treatment of recurrent or persistent urethral strictures that have not responded to other treatments

Types of Urethrotomy

• Optical Urethrotomy (OU): a minimally invasive procedure using a specialized endoscope to visualize the stricture and cut it with a laser or knife
• Direct Vision Internal Urethrotomy (DVIU): a procedure that uses a cystoscope to directly visualize the stricture and cut it with a knife or laser

Surgical Technique

The surgical technique for urethrotomy typically involves the following steps:

• Administration of general or regional anesthesia to ensure patient comfort and relaxation
• Insertion of a cystoscope or endoscope into the urethra to visualize the stricture
• Identification and marking of the stricture using a special dye or contrast agent
• Cutting of the stricture using a laser, knife, or other specialized instrument
• Dilation of the urethra to ensure proper healing and prevent recurrence of the stricture

Postoperative Care and Recovery

After urethrotomy, patients typically require:

• A short period of hospitalization for observation and monitoring
• A urinary catheter to drain urine and allow the urethra to heal
• Pain management with medication and other interventions as needed
• Follow-up appointments with a healthcare provider to monitor healing and remove any sutures or catheters

Risks and Complications

As with any surgical procedure, urethrotomy carries certain risks and complications, including:

• Bleeding or hemorrhage
• Infection or sepsis
• Damage to surrounding tissues or organs
• Recurrence of the stricture
• Urinary incontinence or other urinary problems

Success Rates and Outcomes

The success rate for urethrotomy varies depending on the severity and location of the stricture, as well as the individual patient's overall health. Generally:

• Short-term success rates are high, with up to 90% of patients experiencing significant improvement in urine flow
• Long-term success rates are lower, with up to 50% of patients experiencing recurrence of the stricture within 5 years

Alternatives and Additional Treatments

In some cases, alternative or additional treatments may be recommended, including:

• Dilation of the urethra using a balloon or other instrument
• Urethral stenting to maintain urine flow and prevent recurrence of the stricture
• Open surgical repair or reconstruction of the urethra