Urethrotomy: Procedure, Uses, Side Effects and Results

Urethrotomy

Treatment Duration

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30 Minutes

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45 Minutes

Treatment Cost

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35,000

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90,000

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Urethrotomy

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Painful urination or an inability to empty the bladder can be highly distressing. Urethral stricture refers to the narrowing of the urethra and is the reason why people are unable to pass urine freely. But doctors have found a way to relieve patients of such problems.

Urethrotomy, also called direct vision internal urethrotomy, is a simple surgery to remove urethral strictures and make passing urine easy and painless. Specialists usually perform this surgery on men as strictures are rare in women.
Surgery Name Urethrotomy
Alternative Name Direct Vision Internal Urethrotomy
Diseases Treated Urethral stricture disease, Urinary tract infection, Infection of the testes or prostate, Urinary bladder stone, Hydronephrosis 
Benefits of the Surgery Immediate relief from symptoms, Fewer chances of infection, Short recovery period, Quick procedure
Treated by Urologist

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What is Urethrotomy?

Urethrotomy is a surgical procedure to deal with the narrowing of the urethra (the tube that consists of urine to the end of the penis). The narrowing (stricture) is generally because of scar tissue forming after inflammation,  contamination or injury.

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.

Conditions treated with Urethrotomy

Urethrotomy is generally performed to get relief from a urethral stricture. However, this procedure also help in treating the following conditions:
  1. Urinary tract infection
  2. Infection of the testes or prostate
  3. Urethral abscess
  4. Urinary bladder stone
  5. Hydronephrosis
  6. Kidney failure

Who needs Urethrotomy?

A doctor generally recommends urethrotomy to a patient who:
  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.

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How is Urethrotomy performed?

Being an invasive procedure, it can usually take about 30 to 45 minutes, depending on the patient's health condition. The operation is done under general or spinal anaesthesia to make the patients comfortable. The patient is taken into the room after other preoperative formalities. 
  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.

What to expect before and on the day of Urethrotomy?

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.

What to expect after Urethrotomy?

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.

Benefits of Urethrotomy

Urethrotomy is a safe procedure. Below mentioned are some of the benefits of urethrotomy.
  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.

Risks and complications of Urethrotomy

There are some risks and complications that one may experience after a urethrotomy. Among the most typical ones are:
  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. 
Other unusual and severe consequences include:
  1. Blood loss
  2. Swelling in the Penis
  3. Difficulty in urination

When is consultation with the doctor needed?

The patient can visit the doctor if he is facing any kind of discomfort, such as:
  1. Symptoms of urinary infection
  2. Swelling of the penis
  3. Inability to pass urine
  4. Excessive bleeding 

Risks of delayed Urethrotomy

Urine is not entirely emptied from the bladder if a urethrotomy is not performed on time. The effects of retention of urine can be severe and painful.
  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

Cost of Urethrotomy

The cost of urethrotomy ranges from ₹45,000 to ₹85000  The cost varies based on the following factors:
  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
Procedure Name Cost Value
Urethrotomy ₹35,000 to ₹90,000

Frequently Asked Questions (FAQ)

Urethrotomy, also called direct vision internal urethrotomy, is a simple surgery to remove urethral strictures and make passing urine easy and painless.
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Urethrotomy usually lasts for about 30-60 minutes.
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No, Urethrotomy is a minor surgical procedure which is minimally invasive and has low chances of complications.
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The success rate of Urethrotomy is 60-70% for the initial one year. However after a year the chances of recurrence increase by 50%.
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A urethrotomy surgery is performed under General Anaesthesia by a surgeon. This means the patient falls asleep during the procedure and does not feel any kind of pain.
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The catheter stays in the bladder for about 24-48 hours after the procedure. Bleeding around the catheter is normal.
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The patient is usually hospitalised for 2-3 days after the surgery. The patient should limit their physical activity for a week or two. The patient is advised to wear a Scrotal Support for a week.
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The narrowing of strictures is usually caused by a scar tissue that is formed after an infection, inflammation or injury.
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Food items like Grapes, apricots, eggplant, spinach, milk, pumpkin and carrot are the best foods for urethral strictures.
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Minor Bleeding followed by Optical Internal Urethrotomy is pretty common and usually subsides spontaneously or with perineal compression.
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The doctor inserts the cystoscope with a surgical knife at the end into the urethra through the penis. The area of the stricture is cut and opened up for urine to flow freely. The bladder is then washed and drained with the irrigation fluid and a catheter is attached to the bladder.
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The Half Tortoise post i.e the Ardha Kurnasaba is the best exercise for Urethral Strictures since it stimulates the digestive, respiratory and urinary system.
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Food items like Yoghurt, fermented cheese, kimchi and other probiotics are effective in dealing with urethral strictures at home. These food items promote growth of good bacteria and help in fighting inflammation and infection of the urinary tract.
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The patient may experience pain while urinating, increased urge to urinate and might see some bleeding.
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  1. Myth: Urethrotomy is painful
    Fact: Urethrotomy is performed under General Anaesthesia, and the patient doesn't feel any pain
  2. Myth: It takes a long time for a patient to recover after Urethrotomy
    Fact: The catheter is usually removed 24-48 hours after the surgery and the patient can return to normal activities within a week.
  3. Myth: Urethral Strictures always reoccur.
    Fact: Although Urethral Strictures have a high recurrence rate, they don't always develop again. Maintaining good hygiene and regular checkups can reduce the chances of recurrence. 
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