Name of the Procedure:

Cystourethroscopy with Internal Urethrotomy; Male

Summary

Cystourethroscopy with internal urethrotomy is a surgical procedure used to examine the inside of the bladder and urethra, and to treat any obstructions within the urethra in males. The procedure involves using a cystoscope (a thin, flexible tube with a camera) to locate and cut through scar tissue causing the obstruction.

Purpose

• Condition Addressed: Urethral stricture (narrowing of the urethra due to scar tissue).
• Goals: To relieve obstruction, restore normal urinary flow, and alleviate symptoms such as difficulty urinating, pain, or urinary tract infections.

Indications

• Difficulty starting or maintaining urine flow.
• Reduced urinary stream.
• Frequent urinary tract infections.
• Pain during urination.
• Urinary retention.

Preparation

• Pre-Procedure Instructions: Patients may be required to fast for a few hours before the procedure and adjust certain medications as per their doctor's instructions.
• Diagnostic Tests: Preoperative imaging or tests like uroflowmetry or ultrasound may be conducted to assess the severity and location of the stricture.

Procedure Description

1. Anesthesia: The patient may receive general or spinal anesthesia to ensure comfort during the procedure.
2. Insertion: A cystoscope is inserted gently through the urethra up into the bladder.
3. Examination: The surgeon inspects the urethra and bladder for strictures and other abnormalities.
4. Internal Urethrotomy: Special instruments are used to cut through the scar tissue causing the urethral stricture.
5. Completion: The bladder may be irrigated, and the cystoscope is carefully withdrawn.

Duration

The procedure typically takes between 30 minutes to 1 hour.

Setting

This procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Urologist or specialized surgeon.
• Nursing staff.
• Anesthesiologist.

Risks and Complications

• Infection.
• Bleeding.
• Recurrent urethral stricture.
• Urinary incontinence.
• Injury to the urethra or bladder.

Benefits

• Relief from urinary obstruction.
• Improved urinary flow.
• Reduction in urinary tract infections.
• Symptoms relief is often experienced shortly after the procedure.

Recovery

• Post-Procedure Care: Patients might have a catheter inserted temporarily to help with urine drainage.
• Recovery Time: Generally, recovery is quick, with most patients resuming normal activities within a few days.
• Restrictions: Avoid heavy lifting and vigorous activities for a week or as advised.
• Follow-Up: Regular follow-up appointments to monitor healing and check for recurrence of stricture.

Alternatives

• Dilation: Gradual stretching of the stricture with specialized instruments.
• Open Surgery: Urethroplasty for severe cases.
• Pros and Cons: Dilation is less invasive but may provide only temporary relief. Urethroplasty is more invasive but may offer a more permanent solution.

Patient Experience

During the procedure, the patient is under anesthesia and should not feel pain. Afterward, there may be some discomfort or a burning sensation when urinating, which can typically be managed with pain relievers. Any significant pain, fever, or difficulty urinating should be reported to the doctor immediately.