Urethrotomy: Procedure, Uses, Side Effects and Results

Anatomy and Physiology of Urethra

1. The urethra is a vital organ that helps empty the urine collected in the bladder. It differs in length for males and females. 
2. The male urethra is 7 to 8 inches in length.
3. It has three sanctions: the prostatic urethra, membranous urethra and spongy urethra.
4. In males, apart from carrying urine from the bladder, it also transports semen.
5. Sphincter muscles surround the membranous urethra and help to control urination.
6. Strictures can be present in any part of the urethra.
7. The prostatic urethra uses the inferior vesical artery, the membranous urethra uses the bulbourethral artery, and the spongy urethra uses the pudendal artery for its supply of blood.

1. Urinary tract infection
2. Infection of the testes or prostate
3. Urethral abscess
4. Urinary bladder stone
5. Hydronephrosis
6. Kidney failure

1. Experiences pain when passing urine because of urethral stricture.
2. Suffer from frequent urinary tract infections arising from urine retention in the bladder.
3. Suffer from spraying urine.
4. Is unable to empty his bladder.

1. The patient is made to change into a sterile hospital gown to facilitate easy access to the operative area.
2. The doctors make the patient lie on his back, spread the thighs and pull the knees towards the stomach. This position provides easy access to the penis.
3. At the operation theatre, doctors administer antibiotics to prevent the chances of infection.
4. The anaesthetist will administer spinal or general anaesthesia as per the patient's condition. The medicine is injected at a spot close to the spinal cord for spinal anaesthesia. 
   1. In the case of general anaesthesia, the patient is fully asleep. With spinal anaesthesia, the area below the hip is completely numb. 
5. Once the patient is under the drug's effect, the doctor will insert a cystoscope into the urethra through the penis. The cystoscope has a surgical knife at its end. 
6. The urologist can clearly see the area where the stricture is present through the cystoscope.
7. The specialist will open up the stricture area using a surgical knife until an opening is wide enough to allow urine to pass freely. 
8. The bladder is then emptied of urine and filled with irrigation fluid. This liquid helps in washing and rinsing the area where the incision occurred. 
9. Doctors attach a catheter to the bladder and drain the irrigation fluid. This catheter is left there for the patient to pass urine freely. 
10. The instruments are removed from the penis.
11. The nurse then moves the patient to the recovery room where the patient will remain until he is awake.

Prior to the urethrotomy, the doctor/surgeon will discuss and prepare the patient for the surgery. These steps often involve:

Before Urethrotomy

1. Doctors assess the stricture length using imaging tests or cystoscopy. It also helps the specialist know the severity of the problem. 
2. The patient has to give a sample of his urine to check for the presence of bacteria.
3. The medical staff will conduct blood tests to assess the patient's health.
4. The specialist will discuss the type of anaesthesia to be used with the patient.
5. Dietary restrictions before the surgery will also be informed to the patient. 
6. The specialist will briefly tell the patient about the procedure and the time it takes to complete. 
7. Patients must also disclose information about regular medicines and any previous serious illnesses. 
8. The specialist will inform the patients about the risks involved in the procedure.

On the day of Urethrotomy

1. The patient must:
   1. Not eat for at least 8 hours before the surgery.
   2. Reach the hospital before the scheduled time.
   3. Sign the consent form before the surgery.
   4. Hand over all jewellery and other expensive materials to their family.
2. It is better to have loose-fitting underwear ready as the patient will be attached to a catheter after the surgery.
3. Nurses take note of the patient's vital signs before the procedure.
4. The patient is then moved to the operation theatre.

A patient who has undergone urethrotomy can expect the following after the surgery:

The recovery process in the hospital

1. The patient will be moved to the post-operative recovery room to gain complete consciousness.
2. The nurse will monitor the temperature, pulse rate, respiration and blood pressure at regular intervals.
3. IV fluids will be passed into the bloodstream as oral medication, or food cannot be given till the patient is fully conscious.
4. When the patient regains consciousness, the nurse will inquire about the pain or other discomforts.
5. Additional pain medication will be administered on advice from the doctor. 
6. Once the patient is comfortable, he will be moved to the ward till discharge.
7. In most cases, the patients can leave the hospital the next day.
8. Health workers will advise the patient about how to manage the attached catheter.

Recovery process/expectation after hospital discharge

1. The catheter attached to the bladder will remain there for a few days to help heal.
2. Doctors will prescribe antibiotics to prevent the occurrence of any infection.
3. The patients can start their regular activities in a few days.
4. Sexual intercourse must be avoided for a couple of weeks or till the doctor gives the go-ahead.
5. Straining during bowel movements must be avoided.
6. Patients must maintain a healthy diet to help get back to normal very quickly.
7. Eating food with high fibre content and drinking enough fluids help in preventing constipation. 

First follow-up appointment

1. The first follow-up will be scheduled within 6 to 8 weeks after surgery.
2. Patients must visit the doctor for the removal of the catheter when instructed.
3. Doctors will conduct a test to check the quantity of urine, the time taken to complete the process and the quality to ensure that the surgery was successful.
4. The same test is repeated after a few weeks to ensure that the urethra stays open.
5. The doctor might also change the medication or advise the patient to continue with the previous medication for some more time, depending on the condition and recovery of the surgical area. 
6. The doctor will advise the patient for further timely follow-ups as well.

1. Immediate relief from symptoms associated with urethral stricture.
2. The procedure is quick, and the patient can leave the hospital within a day.
3. It is possible to perform this with local or regional anaesthesia, reducing pain and operative risks. 
4. The chances of infection are less with this operation.
5. There is a very short period (approximately 2 weeks) of recovery for this procedure.

1. Urethral discomfort: After surgery, it's typical to have some soreness or burning when peeing for a few days.
2. Bleeding: Frequent bleeding and urination are expected after the surgery. It should go away within a week after the procedure. 
3. Infection: Fever and chills are classic indicators of an infection. One should contact their healthcare professional if they develop any such symptoms. 
4. Recurrence of the stricture: The urethra may constrict or form a stricture again since the recurrence rate is very high. 

1. Blood loss
2. Swelling in the Penis
3. Difficulty in urination

When is consultation with the doctor needed?

1. Symptoms of urinary infection
2. Swelling of the penis
3. Inability to pass urine
4. Excessive bleeding 

1. Stone formation in the bladder
2. Swelling of the kidney
3. Frequent occurrence of urinary tract infection
4. Formation of abscesses around the urethra
5. Infection of the testes or prostate
6. Failure of the kidney in long-standing stricture

1. Patient’s age
2. The technology used
3. The medical condition of the patient
4. The type of hospital facility availed: an individual room or shared