Urethrotomy indications

Initially, urethral strictures were treated with simple treatments, followed by more complicated procedures if necessary. Before considering an open surgery, internal urethrotomy or multiple attempts of urethrotomy were performed. Below are some of the indications for urethrotomy:

• Short urethral strictures: The position and length of the stricture determine whether endoscopic treatment is necessary. Urethrotomy is the most effective treatment for simple and short bulbar urethral strictures. 
• Meatal stenosis: Meatal stenosis is a constriction of the urethra, the tube through which urine comes out of the body. It is caused by irritation of the urethral opening at the tip of the penis, which causes tissue development and scarring across it. 
• Chronic cystitis: It is an inflammation of the bladder that is usually caused by an infection. Chronic cystitis, also called interstitial cystitis, can be treated with urethrotomy. 
• Recurrent cystitis: Cystitis occurs frequently in women, in particular. Recurrent infection is defined by doctors as having three confirmed distinct infections in a year or two in six months. In many cases, there is no apparent cause for a woman to get cystitis so frequently. 
• Bladder outlet obstruction: Bladder outlet obstruction (BOO) is a relatively rare urologic problem in women, but it can cause discomfort. Internal urethrotomy is used to treat females with anatomical bladder outlet obstruction. 

Urethrotomy may also be indicated in traumatic urethral injury to relieve urinary obstruction and improve urinary flow in patients with persistent symptoms.

Urethrotomy contraindications

Urethrotomy surgery is unsafe in some conditions; hence, it is not recommended. Below are some of the situations where urethrotomy is not recommended:



• Untreated urinary tract infection: A urinary tract infection, also termed as UTI, is an infection of the urinary tract. Several locations throughout the urinary system may become infected with the illness, including the bladder, kidneys, ureters, and urethra. 
• Coagulation disorders: Sometimes, blood clotting disorders are referred to as thrombophilia’s or coagulation disorders. These disorders involve issues with the body's capacity to regulate blood clotting . 
• Failure of previous urethrotomy: A repeat urethrotomy following a last unsuccessful surgery has a success rate of 10% and is hence generally not recommended. 
• Complex Strictures: Most specialists believe that shorter strictures can be treated by urethrotomy/dilatation in the first instance, especially if they are in the bulbar urethra. In comparison, longer strictures should be treated with primary urethroplasty first. 
• Purulent urethritis: The inflammation of the urethra and purulent discharge are known as purulent urethritis. 
• Periurethral abscesses: Like other genitourinary pathologies, periurethral abscesses can present with fever, dysuria, pyuria, and acute urine retention along with pain (scrotal, penile, pelvic, perineal, or suprapubic). 
• Suspicion of urethral carcinoma: Urethral carcinoma, also known as primary urethral carcinoma (PUC), is a rare type of cancer that begins in the urethra, the tube that transports urine out of the body.
  

A urethrotomy is a surgical operation that is performed for males who have diminished urine stream because of urethral stricture (a narrowing of the urethra). Below are some of the advantages of urethrotomy:

• Improved urinary flow: Patients will have a better flow of urine (stronger stream) after urethrotomy.
• Improved bladder emptying: After undergoing a urethrotomy procedure, patients will have enhanced bladder emptying and will not need to pass urine as frequently during the night.
• Less susceptible to infections: Patients are also less likely to develop urinary tract infections. 
• Relief from urinary obstruction: The primary goal of the surgery is to relieve urinary blockage.
• Minimally invasive: Urethrotomy is a minimally invasive surgical procedure that can cure or significantly improve urinary problems in the majority of cases. 
• Less recovery time: It has a quick recovery and minimal downtime following surgery. 
• For urethral strictures: Internal urethrotomy is an effective treatment for male urethral strictures due to its ease, simplicity, and quickness.
  

The urethrotomy surgery involves the following steps:

• Patients who regularly take antiplatelet medication or other blood thinners should consult their urologist because these medications can cause more bleeding after surgery. There may be a risk-benefit balance in which stopping them reduces the likelihood of bleeding but increases clotting, which could lead to a risk to their health. As a result, a thorough examination of risks and benefits may be required.
• Patients can continue taking their regular medications until the day of their procedure. If the surgeon or anesthetist advises against taking regular medicines, they will discuss the possibilities.
• Individuals with chronic medical conditions, such as diabetes, hypertension, asthma, or epilepsy, need a check-up from their primary care physician. 
• Patients often get admitted on the same day as their surgery. Patients will usually undergo pre-assessment on the day of their appointment to check their overall fitness, screen for Methicillin-resistant Staphylococcus aureus (MRSA) carriage and do baseline assessment tests.
• After admission, patients will be seen by healthcare team members, including the consultant, junior urology doctors, and the designated nurse.
• Patients will be asked not to drink or eat for six hours before surgery, and the anesthetist may provide a pre-medication that will leave them dry-mouthed and comfortably sleepy. 
• If patients smoke, consider quitting for a few weeks before the surgery.
• Smoking decreases oxygen levels in the blood, increasing the risk of respiratory issues during and after surgery.
• Patients with loose or damaged teeth or crowns may require care from their dentist. Typically, the anesthetist will insert an airway into the mouth to aid breathing. If the teeth are not secured, they may be damaged. 
• It is essential that patients contact their urologist in advance of surgery if they have any of these conditions: an artificial heart valve, a coronary artery stent, an artificial joint, a heart pacemaker or defibrillator an artificial blood vessel graft, any other implanted foreign body, a neurosurgical shunt a previous or current MRSA infection, a high risk of variant CJD (if patients have received a corneal transplant, a neurosurgical dural transplant, or past injections of human-derived growth hormone).
  

During the urethrotomy procedure

• Patients will be given either a full general anesthetic (where they will be sleeping throughout the treatment) or a spinal anesthetic (where they will be awake but unable to feel anything below the waist). These reduces pain; the anaesthesiologist will discuss the benefits and drawbacks of each type of anesthetic with patients.
• After a thorough allergy assessment, patients are usually given injectable antibiotics before the surgery.
• The procedure involves inserting a telescope into the penis via the urethra.
• Any narrowing caused by stricture can then be cut with a special internal knife or laser probe.
• There are no incisions or stitches because the entire procedure is performed internally.
• Most individuals require a catheter inserted into their bladder for 3-7 days after the procedure.
• The catheter can be removed later when appropriate by the doctor.
  

• Patients will be brought to the recovery room and then moved to the general or daycare ward. They need to rest until the anesthetic wears off. A drip in the arm will keep them hydrated. 
• Patients are recommended to walk around as quickly as possible to prevent blood clots and chest infections. 
• As a result of the incision in the urethra that surrounds the catheter, there will often be some bleeding.
• This usually lasts for a short time unless multiple or severe incisions are required.
• A pad will often be placed around the end of the penis to absorb any blood that leaks out around the catheter; this pad is removed on the day after surgery.
• Patients will be able to pass urine with better flow after the catheter is removed, but this is sometimes painful and bloody in the early stages. If patients drink plenty of fluids, this will subside with time.
• When they return to the hospital, patients will be asked to undergo a voiding flow rate test to measure how quickly they pass urine.
• Patients are advised to arrive at their hospital appointments with a comfortably full bladder since this measurement will be utilized as a baseline to compare to future measurements.
• Following the surgical procedure, patients may be trained on how to self-catheterize using a "slippery" catheter to keep their urethral stricture open. This instruction is usually given in the outpatient clinic five to seven days after the surgery.
• The usual hospital stay lasts 12 to 36 hours.