Why do I need an optical urethrotomy?
You may be recommended this procedure if you have as narrowed segment in your urethra, due to scar tissue, which is causing an obstruction to the urinary stream.
What does the procedure involve?
Inspection of the urethra, using a telescope, and making an internal cut in the constricting scar tissue using a knife or laser fibre passed through the telescope.
What are the alternatives to this procedure?
Alternatives to this procedure include:
- Urethral dilation under anaesthetic.
- Urethroplasty - open (non-telescopic) surgical repair of the narrowed segment of urethra.
- No treatment / observation of symptoms.
What should I expect before the procedure?
You will usually be admitted to hospital on the same day as your surgery. You may receive an appointment for a “pre-assessment” to assess your general fitness.
You will be asked not to eat and drink for six hours before surgery.
Immediately before the operation, the anaesthetist may give you a pre-medication, which will make you dry-mouthed, and feel pleasantly sleepy.
Please tell your surgeon (before your surgery) if you have any of the following:
- An artificial heart valve.
- A coronary artery stent.
- A heart pacemaker or defibrillator.
- An artificial joint.
- An artificial blood-vessel graft.
- A neurosurgical shunt.
- Any other implanted foreign body.
- A regular prescription for a blood thinner e.g. Warfarin, Coumadin Xarelto®, Pradaxa®, Clopidogrel (Plavix®), Brilinta®, or Aspirin.
- Previous or current infection with an antibiotic resistant organism such as MRSA, VRE, etc.
What happens during the procedure?
Either a full general anaesthetic (where you will be asleep) or a spinal anaesthetic (where you are unable to feel anything from the waist down) will be used. All methods reduce the level of pain. Your anaesthetist will explain the pros and cons of each type of anaesthetic to you. You will usually be given injectable antibiotics before the procedure, after checking for any allergies.
The surgeon will insert a telescope into the penis through the water pipe (urethra). Any narrowing will then be cut using a special internal knife (pictured above) or a laser fibre. All of the cutting takes place internally and there are no incisions or stitches. Most patients need a bladder catheter for 24 to 48 hours afterwards.
What happens immediately after the procedure?
You will often have some bleeding around the catheter because the cut is made in the waterpipe (urethra) that surrounds the catheter. This usually lasts for a short period unless the surgeon has made multiple or deep cuts. A pad will often be secured around the end of the penis to collect any blood that seeps out around the catheter; this is usually removed the next day. Once the catheter has been removed, you should be able to pass urine with an improved flow. In the early stages, this can be painful and bloodstained but, provided you drink plenty of fluid, this will gradually settle over a few days.
After the operation, you may be instructed in self-catheterisation by the urology nurse, using a “slippery” catheter, to keep your urethral stricture open.
The average hospital stay is 1-2 days.
Are there any side-effects?
Most procedures are straightforward; however as with any surgical procedure there is a chance of side effects or complications.
Risks of the anaesthetic need to be discussed with the anaesthetist who will be looking after you during the operation, and who will visit you beforehand.
Common (greater than 1 in 10)
- Mild burning or bleeding on passing urine for a short period after the operation.
- Need for intermittent self-catheterisation to keep the narrowing from closing down again.
- Recurrence of narrowing needing further procedures or repeat incision.
Occasional (between 1 in 10 and 1 in 50)
- Infection of the bladder needing antibiotics.
- Delayed bleeding requiring removal of clots or further surgery.
Rare (less than 1 in 50)
- Decrease in the quality of erections.
- Septicaemia.
- Inability to open stricture and need for a temporary suprapubic catheter.
What should I expect when I get home?
When you get home, you should drink twice as much fluid as you would normally for the next 24 to 48 hours. When you first pass urine, you may find that, it burns slightly and it may be lightly bloodstained. If you continue to drink plenty of fluid, this will settle rapidly. If you need to learn self-catheterisation, you will be given an appointment to see the urology nurse.
What else should I look out for?
If you develop a fever, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your Surgeon immediately. If out of hours, please go to your nearest emergency department.
Are there any other important points?
Following a first-time operation, 40% of men require no further treatment but, if the stricture recurs, you may need a further procedure carried out. In the longer term, you may be advised to continue self-catheterisation for several months to prevent recurrence of your stricture.
Disclaimer
This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional.
Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.