Name of the Procedure:

Dilation of Female Urethra
Common Names: Urethral dilation
Technical Terms: Urethral Calibration, Urethrotomy

Summary

Urethral dilation is a medical procedure that involves widening the urethra (the tube that carries urine from the bladder out of the body) to treat blockages or constrictions (strictures). This procedure is performed under general or conduction (spinal) anesthesia to ensure the patient is comfortable and pain-free.

Purpose

Medical Condition Addressed: Urethral strictures or narrowing of the urethra
Goals: To relieve urinary obstruction and improve urine flow, reducing symptoms like difficulty urinating, frequent urinary tract infections, and discomfort.

Indications

Symptoms/Conditions:

• Difficulty or pain during urination
• Frequent urinary tract infections (UTIs)
• Decreased urine flow or spraying Patient Criteria:
• Diagnosed urethral stricture via imaging or cystoscopy
• Recurrent UTIs attributed to urethral narrowing

Preparation

Pre-Procedure Instructions:

• Fast for at least 6-8 hours before the procedure
• Adjust certain medications as advised by your doctor (e.g., blood thinners) Diagnostic Tests:
• Urinalysis
• Imaging studies (e.g., ultrasound, MRI)
• Cystoscopy to visualize the urethra

Procedure Description

1. Anesthesia: Administered either general or conduction (spinal) anesthesia.
2. Positioning: Patient positioned on the exam table, typically in a lithotomy position.
3. Dilation:
   • A series of progressively larger dilators are gently inserted into the urethra to gradually widen it.
   • Lubricant is used to ease insertion and reduce discomfort.
4. Completion: The dilators are removed, and the procedure is concluded.

Tools/Equipment:

• Sterile lubricating jelly
• Urethral dilators (e.g., Van Buren sounds, filiforms, and followers)

Duration

Typically takes about 15 to 30 minutes.

Setting

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

Personnel

• Urologist or specialized surgeon
• Anesthesiologist
• Nurses or surgical assistants

Risks and Complications

Common Risks:

• Mild bleeding
• Temporary discomfort or pain
• Urinary tract infections

Rare Complications:

• Urethral injury or perforation
• Severe bleeding
• Stricture recurrence

Management of Complications:

• Antibiotics for infections
• Follow-up procedures for severe complications

Benefits

Expected Benefits:

• Improved urine flow
• Relief from urinary symptoms
• Reduced frequency of urinary tract infections Timeline for Benefits: Usually realized immediately after recovery from anesthesia.

Recovery

Post-Procedure Care:

• Hydrate well to flush the urinary tract
• Avoid strenuous activity for a few days
• Take prescribed antibiotics if given Recovery Time: A few days to a week
  Follow-Up: Scheduled follow-up appointments to monitor healing and ensure the stricture does not recur.

Alternatives

Other Treatment Options:

• Urethral stenting
• Direct visual internal urethrotomy (DVIU)
• Surgical reconstruction Pros and Cons:
• Urethral stenting: Immediate relief but may require another procedure
• DVIU: Effective for short strictures but may have a higher recurrence rate
• Surgical reconstruction: More invasive but potentially offers a permanent solution

Patient Experience

During the Procedure: Under anesthesia, so no pain or discomfort.
After the Procedure: Some soreness and mild pain which can be managed with prescribed pain relievers. Careful monitoring for signs of infection or complications. Instructions on hygiene and activity levels provided to promote healing.