Name of the Procedure:

Urethrotomy or Urethrostomy, External (Separate Procedure); Pendulous Urethra

Summary

Urethrotomy or urethrostomy of the pendulous urethra is a surgical procedure to create an opening in the urethra or to remove obstructions. It is aimed at allowing urine to flow more freely or addressing strictures (narrowing) in the urethral passage.

Purpose

The procedure addresses conditions related to urethral strictures and obstructions that can lead to difficulty in urination, pain, infections, or other complications. The goals are to restore normal urine flow, reduce symptoms, and prevent recurrent infections or damage to the urinary tract.

Indications

• Recurrent urethral strictures
• Chronic urinary retention
• Severe difficulty in urination
• Persistent urinary tract infections (UTIs) related to strictures

Preparation

• Fasting for several hours prior to the procedure
• Discontinuation or adjustment of certain medications as advised by the physician
• Pre-procedure diagnostic tests, like urinalysis, ultrasound, or urethroscopy, to assess the stricture

Procedure Description

1. Anesthesia administration, usually general or spinal.
2. Placement of a catheter in the urethra.
3. A small incision is made at the site of the stricture in the pendulous urethra.
4. Use of a surgical tool (urethrotome) to cut and widen the stricture.
5. In some cases, additional stents or catheters may be positioned to help keep the urethra open.
6. Closing the incision, if needed, with sutures or allowing it to heal naturally.

Tools: Urethrotome, catheter, stents

Anesthesia: General or spinal anesthesia

Duration

The procedure typically takes about 30 minutes to an hour.

Setting

Performed in a hospital operating room or an outpatient surgical center.

Personnel

• Urologist (surgeon specialized in urinary tract conditions)
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Recurrence of urethral stricture
• Injury to surrounding tissues or organs
• Scar tissue formation

Benefits

• Improved urinary flow
• Relief from symptoms like pain and discomfort
• Reduced risk of recurrent UTIs and bladder damage
• Potential improvement in overall quality of life

Recovery

• Initial recovery in a post-anesthesia care unit (PACU)
• Possible overnight hospital stay
• Instructions on catheter care, if applicable
• Pain management with prescribed medications
• Avoid heavy lifting and strenuous activities for several weeks
• Follow-up appointments to monitor healing and ensure the stricture does not recur

Alternatives

• Urethral dilation: Temporarily widening the stricture with increasing sizes of tubes
• Urethral stent placement: Inserting a tube to keep the urethra open
• Open urethroplasty: Surgical reconstruction of the urethra

Pros and Cons:

• Urethrotomy is less invasive compared to open urethroplasty but may have a higher recurrence rate.
• Dilation offers short-term relief but often needs repeated treatments.
• Stent placement is less common for long-term management due to potential complications.

Patient Experience

During the procedure: Patients will be under anesthesia and should not feel pain.

After the procedure: Mild to moderate pain managed with medications, possible discomfort from the catheter, and generally a gradual return to normal activities.