Name of the Procedure:

Urethrolysis, transvaginal, secondary, open, including cystourethroscopy (e.g., postsurgical obstruction, scarring)

Summary

Urethrolysis is a surgical procedure aimed at relieving blockage or scarring in the urethra, typically stemming from previous surgeries. By conducting the procedure transvaginally, the surgeon gains direct access to the urethra to remove constrictions, thus restoring normal urine flow. Cystourethroscopy is also performed to visually inspect the urethra and bladder.

Purpose

Urethrolysis is primarily performed to address urethral obstruction or scarring often resulting from previous surgeries. The main goal of the procedure is to alleviate urinary difficulties by ensuring the urethra is free from obstructions, thus improving urinary function and patient comfort.

Indications

• Difficulty urinating due to urethral obstruction or scarring from previous surgeries
• Urinary hesitancy or retention
• Incomplete bladder emptying
• Painful urination caused by structural abnormalities in the urethra

Preparation

• Pre-procedure fasting, typically starting from midnight before the surgery
• Adjustments or temporary cessation of certain medications as advised by the physician
• Pre-operative diagnostic tests such as urinalysis, imaging studies, or urodynamic tests to assess urinary function

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Access: An incision is made transvaginally to access the urethra.
3. Cystourethroscopy: A scope is inserted to visualize the urethra and bladder.
4. Dissection: Surgical instruments are used to carefully dissect and release scar tissue or obstructions.
5. Inspection: The urethra is inspected to ensure patency.
6. Closure: Incisions are sutured, and appropriate dressings are applied.
7. Recovery from anesthesia: Transfer to a recovery area for monitoring until the patient awakens.

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

Urethrolysis is usually performed in a hospital or surgical center equipped for major surgeries.

Personnel

• Urologist or gynecologist specialized in pelvic floor and reconstructive surgery
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma
• Injury to surrounding organs such as the bladder or vagina
• Recurrence of urethral obstruction or scarring
• Pain or discomfort during recovery
• Urinary incontinence

Benefits

• Alleviation of urinary obstruction
• Improved urinary flow and bladder emptying
• Reduction in symptoms such as painful urination or urinary retention
• Enhanced quality of life

Recovery

• Instructions on wound care and hygiene
• Possible use of a urinary catheter for initial days post-surgery
• Pain management with prescribed medications
• Avoidance of strenuous activities and heavy lifting for several weeks
• Follow-up appointments to monitor healing and ensure urinary function improvements

Alternatives

• Catheterization: Inserting a catheter to bypass the obstruction
• Urethral dilation: Stretching the narrowed urethra
• Endoscopic procedures: Minimally invasive options to clear obstructions
• Pros of alternatives: Less invasive, shorter recovery time
• Cons of alternatives: Possible need for repeated treatments, less definitive relief

Patient Experience

During the procedure, the patient will be under anesthesia and thus feel no pain. Post-procedure, there might be discomfort or mild pain at the incision site, manageable with medications. Some patients may experience temporary urinary symptoms as they heal. Comfort measures include prescribed pain relievers, gentle activity, and follow-up care to ensure a smooth recovery.