Name of the Procedure:

Urethromeatoplasty, with partial excision of distal urethral segment (Richardson type procedure)

Summary

Urethromeatoplasty is a surgical procedure that involves the partial removal of the distal segment of the urethra, often performed to address issues with the urethral opening. The Richardson type is a specific technique used for this purpose.

Purpose

The procedure is performed to correct abnormalities or obstructions of the urethral meatus (the external opening of the urethra), such as meatal stenosis (narrowing). The goal is to restore normal urinary function by widening the urethral opening.

Indications

• Difficulty urinating
• Frequent urinary tract infections (UTIs) due to a narrow urethral opening
• Pain or discomfort during urination
• Diagnosed meatal stenosis or other urethral abnormalities

Preparation

• Instructions to fast for a certain period before the procedure.
• Adjustments to current medications may be necessary.
• Preoperative diagnostic tests such as urinalysis or urethroscopy to assess the extent of the condition.

Procedure Description

1. The patient is positioned appropriately, and local or general anesthesia is administered.
2. The surgeon makes an incision at the distal segment of the urethra.
3. The narrowed segment is partially excised.
4. The urethral opening is reshaped and widened.
5. The area is sutured to promote healing and optimal function. Tools used can include scalpels, sutures, and specialized surgical instruments.

Duration

Typically, the procedure lasts about 30 to 60 minutes.

Setting

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

Personnel

• Surgeon (usually a urologist)
• Nurses
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Infection
• Bleeding
• Scarring that might lead to recurrent stenosis
• Urinary incontinence
• Anesthesia-related risks

Benefits

• Improved urinary flow and function
• Reduced frequency of UTIs
• Relief from discomfort during urination
• The benefits can often be realized within a few weeks post-operatively.

Recovery

• Post-procedure care includes instructions on wound care and hygiene.
• Pain management typically involves prescribed medications.
• Avoidance of strenuous activities for a recommended period.
• Follow-up appointments to monitor healing.
• Recovery time is generally a few weeks.

Alternatives

• Meatal dilation, a non-surgical option, but often with temporary results.
• Urethral stenting, a less commonly used approach.
• Each alternative has its own set of pros and cons, often weighed by considering the severity and recurrence of the condition.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-operatively, there may be discomfort or mild pain manageable with medication. The patient will receive instructions to ensure a smooth recovery, and follow-up visits will be scheduled to ensure proper healing and function.