Name of the Procedure:

Dilation of urethral stricture by passage of filiform and follower, male; initial

Summary

This procedure involves widening (dilating) a narrowed section (stricture) of the urethra in males using specialized medical instruments called a filiform and a follower. This initial treatment helps to alleviate urinary obstruction.

Purpose

This procedure is performed to address urethral strictures, which are typically caused by inflammation, infection, surgery, or trauma, that lead to difficulty urinating. The goal is to widen the constricted part of the urethra to allow normal urine flow and alleviate symptoms like pain, urgency, and incomplete bladder emptying.

Indications

• Difficulty urinating
• Pain during urination
• Frequent urinary tract infections
• Incomplete bladder emptying
• Reduced urinary stream
• Urethral stricture confirmed by diagnostic imaging

Preparation

• Fasting may be required several hours prior to the procedure.
• Adjustments to medications might be necessary, particularly blood thinners.
• Pre-procedure imaging studies like a retrograde urethrogram may be conducted.
• Detailed medical history and physical examination.

Procedure Description

1. The patient is positioned on the procedure table.
2. Local or general anesthesia is administered to ensure comfort.
3. The urethral opening and surrounding area are sterilized.
4. A filiform (a thin, flexible wire) is gently inserted into the urethra and navigated through the stricture.
5. Once the filiform is in place, a follower (a tubular instrument) is threaded over the filiform to gradually dilate the stricture.
6. The instruments are removed, and the procedure is completed.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is commonly performed in an outpatient clinic or a hospital setting.

Personnel

• Urologist or trained healthcare provider
• Nurse
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Discomfort or pain during and after the procedure
• Bleeding
• Infection
• Urethral injury or perforation
• Recurrence of the stricture

Benefits

• Relief from urinary symptoms
• Improved urine flow
• Reduced risk of urinary tract infections
• Most benefits are realized shortly after the procedure.

Recovery

• Post-procedure monitoring for a few hours.
• Pain management with medications if needed.
• Instructions on fluid intake and hygiene.
• Avoidance of vigorous activities for a few days.
• Follow-up appointments for monitoring and possibly further treatments.

Alternatives

• Intermittent self-catheterization
• Internal urethrotomy
• Open urethral reconstruction surgery
• Each alternative has its own risks, benefits, and suitability based on the individual case.

Patient Experience

• Mild discomfort during the procedure, mostly alleviated by anesthesia.
• Possible soreness or mild pain in the following days.
• Close follow-up with the healthcare provider can help manage any discomfort and ensure successful recovery.