Optical urethrotomy

What is this?

This procedure involves telescopic inspection of the urethra and bladder with incision of a stricture (narrowing caused by scar tissue) using a visual knife or laser fibre

What alternatives are there?

Observation, urethral dilatation, open (non-telescopic) repair of stricture.

What to expect before procedure

If you are taking Aspirin or Clopidogrel on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits. You will usually be admitted on the same day as your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.

What happens during the procedure?

Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you. You will usually be given injectable antibiotics before the procedure, after checking for any allergies. The operation is performed using a telescope passed into the penis through the water pipe (urethra). Any narrowing due to stricture can then be cut using a special internal knife or a laser probe. All the cutting takes place internally and there are no incisions or stitches. Most patients require insertion of a catheter into the bladder for 24-48 hours after the procedure.

After the procedure

There is often some bleeding around the catheter, as the incision has been made in the waterpipe that surrounds the catheter. This usually lasts for a short period, unless there has been a need for multiple or deep cuts. A pad will often be secured around the end of the penis to collect any blood which seeps out around the catheter; this pad is removed on the day after surgery. Once the catheter is removed, you should be able to pass urine with an improved flow but, in the early stages, this can often be painful and bloodstained. Provided you drink plenty of fluid, this will gradually settle over a few days. Once the initial discomfort has settled, you will be asked to perform a voiding flow rate test to measure how fast you pass urine; this measurement will be used as a baseline to compare with future measurements. After the operation, you may be instructed in the technique of self-catheterisation, using a “slippery” catheter, to keep your urethral stricture open. This instruction usually takes place 5–7 days after your operation in the outpatient clinic. The average hospital stay is 3 days.

Potential side effects