Name of the Procedure:

Dilation of Urethral Stricture by Passage of Filiform and Follower, Male; Subsequent

Summary

This procedure involves using specialized instruments to widen a narrowed section of the urethra. It is typically performed in males with recurring urethral strictures.

Purpose

• Medical Condition: Urethral stricture
• Goals: To alleviate urinary obstruction, improve urine flow, and reduce symptoms associated with urethral narrowing.

Indications

• Difficulty urinating or weak urine stream
• Frequent urinary tract infections (UTIs)
• Painful urination or urinary retention
• Recurrence of urethral strictures that have not responded to previous treatments

Preparation

• Pre-Procedure Instructions: Patients may need to avoid eating and drinking for a specified period before the procedure. Adjustments to medications, especially anticoagulants, might be necessary.
• Diagnostics: Pre-procedure assessment can include urinalysis, urine culture, ultrasound, or urethral imaging studies.

Procedure Description

1. Anesthesia: Local or general anesthesia is administered to ensure the patient is comfortable and pain-free.
2. Positioning: The patient is positioned to give the surgeon clear access to the urethra.
3. Filiform and Follower Insertion: A filiform, a thin, flexible wire, is carefully inserted into the urethra through the stricture. Once passed through, a follower, a larger instrument, is threaded over the filiform to gradually dilate the stricture.
4. Dilation: The process is repeated with progressively larger followers until the desired dilation is achieved.
5. Completion: The instruments are removed, and the procedure site is inspected.

Duration

Typically takes 30-60 minutes.

Setting

Usually performed in an outpatient clinic, hospital, or specialized surgical center.

Personnel

• Urologist or specialized surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurse or assistant

Risks and Complications

• Infection
• Bleeding or injury to the urethra
• Pain or discomfort post-procedure
• Recurrence of the urethral stricture
• Rarely, urethral perforation

Benefits

• Immediate improvement in urine flow and reduction of urinary symptoms.
• Decreased risk of urinary tract infections and other complications related to urinary obstruction.

Recovery

• Post-Procedure Care: Patients might need a temporary urinary catheter to ensure smooth urine flow.
• Instructions: Avoid heavy lifting and strenuous activities for a few days. Follow prescribed medication regimen, including antibiotics, if given.
• Recovery Time: Most patients can return to normal activities within a few days to a week.
• Follow-Up: Scheduled appointments to monitor healing and evaluate for recurrence of the stricture.

Alternatives

• Options: Catheterization, internal urethrotomy, or urethroplasty.
• Pros and Cons: Each alternative has its own risks and benefits. For example, urethrotomy is less invasive but may have a higher recurrence rate, while urethroplasty is more definitive but involves more extensive surgery.

Patient Experience

• During Procedure: With anesthesia, the patient should feel minimal discomfort.
• Post-Procedure: Some pain and discomfort are expected; pain management is typically provided with medications.
• Recovery: Patients will experience improved urine flow soon after the procedure but should follow all postoperative instructions to ensure optimal recovery and reduce the chances of recurrence.