Name of the Procedure:

Dilation of urethral stricture by passage of sound or urethral dilator, male; initial

• Common names: Urethral dilation, Dilation of urethral stricture
• Medical terms: Urethral sound dilation, Urethral bouginage

Summary

Dilation of urethral stricture involves gently widening the narrow part of the urethra using specialized instruments. This helps to relieve urinary difficulties and discomfort caused by the stricture. It is performed under sterile conditions and may require local or general anesthesia depending on individual cases.

Purpose

• To address urethral strictures that restrict urine flow.
• The goal is to restore normal urine flow and alleviate symptoms such as pain, frequent urination, and urinary tract infections.

Indications

• Symptoms include difficulty urinating, a weak urine stream, frequent urination, and urinary tract infections.
• Suitable for patients experiencing significant discomfort or complications related to a urethral stricture.

Preparation

• Patients may need to fast for several hours before the procedure if general anesthesia is used.
• Adjustments to medications, especially blood thinners, may be necessary.
• A pre-procedure urinalysis and sometimes imaging studies such as ultrasound or urethrogram are performed to assess the stricture.

Procedure Description

1. The patient is positioned comfortably, usually lying on their back.
2. Local, regional, or general anesthesia is administered based on the patient's condition and stricture severity.
3. The healthcare provider cleans and sterilizes the surgical area.
4. A lubricated urethral sound or dilator is inserted gently into the urethral opening.
5. The instrument is gradually advanced through the narrowed area to widen the stricture.
6. The process may be repeated with gradually larger instruments until the desired dilation is achieved.
7. The instruments are carefully removed, and the area is cleaned again.

Duration

• The procedure typically takes around 15-30 minutes.

Setting

• Performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Urologist or specialized surgeon.
• Nurses and possibly an anesthesiologist, depending on the type of anesthesia used.

Risks and Complications

• Common risks: Mild discomfort, minor bleeding, infection.
• Rare complications: Urethral injury, false passage creation, significant bleeding.
• Complications are managed with medications, careful monitoring, and follow-up procedures if necessary.

Benefits

• Relief from urinary obstruction and associated symptoms.
• Improved quality of life, potentially noticed immediately or within a few days post-procedure.

Recovery

• Post-procedure discomfort may be managed with pain relievers.
• Patients should drink plenty of fluids and follow any specific care instructions given by their doctor.
• Normal activities can often be resumed within a day or two, but heavy lifting and strenuous activities should be avoided for a week.
• A follow-up appointment is usually scheduled to ensure proper healing and monitor for recurrence of the stricture.

Alternatives

• Urethral stenting, permanent or temporary implants to maintain urethral patency.
• Surgical options like urethroplasty, which involves reconstructing the urethra.
• Interventional procedures such as laser urethrotomy.
• Each alternative has its pros and cons, including varying degrees of invasiveness, recovery time, and success rates.

Patient Experience

• The patient may feel mild pressure or discomfort during the procedure, especially if under local anesthesia.
• Post-procedure, there might be slight burning during urination and minor swelling.
• Pain management is typically achieved with oral medications and warm sitz baths.
• Comfort measures include staying hydrated and avoiding irritants like caffeine and alcohol immediately post-procedure.