A urethrotomy is a procedure to treat a blocked urethra, where an incision is made to relieve a urethral stricture.
What is a Urethral Stricture?
A urethra is a duct that carries urine from the bladder during urination. The urethra is held closed by the urethral sphincter, a muscle that helps keep urine in the bladder.
The urethra’s primary job in males and females is to pass urine outside the body. This thin tube also plays a significant role in ejaculation for men. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Although urethral strictures can develop anywhere from the bladder to the external opening of the water pipe, the most frequent places are at the base of the penis and just inside the water pipe.
Causes and Symptoms of a Urethral Stricture
In many cases, men experience urinary problems as they age which may be caused by inflammation to the prostate gland (prostatitis). In older men, symptoms may be due to an obstruction in the tubes due to a benign (non-cancerous) growth of the prostate gland. The most common symptom is struggling to empty your bladder. In some cases, urinary complications can become so problematic that they require treatment or surgery.
What Causes a Urethral Stricture?
Nowadays, urethral strictures are generally caused by injury as opposed to infection, maybe due to side effects of an examination or treatment that involves the urinary tract. Any damage can result in the build-up of scar tissue that can create problems when passing urine. They can occur at any age and it is possible to have more than one stricture.
It is more common for men to have a urethral disease or injury due to their longer urethra. For this reason, strictures are more likely to occur in men than they are in women or children. Some common causes of a stricture include:
- Trauma to the urethra
- Infection such as a sexually transmitted disease
- Injury from surgical tools
- Conditions that result in swelling
In most cases, no cause can be found.
When a stricture is narrow enough to decrease urine flow, you will usually develop symptoms. Difficulties with urinating, UTIs and swelling or infections of the prostate may follow. Symptoms may include:
- Dark or bloody urine
- Blood in semen
- Slow or reduced urine flow
- Urine stream spraying
- Pain or discomfort when urinating
- Abdominal pain
- Urethral leaking
- UTIs in men
- Inflammation or swelling of the penis
- Loss of bladder control
Diagnosis of a Urethral Stricture
To make a diagnosis, your doctor will ask about your symptoms, your medical history and carry out a physical examination. Your doctor may also suggest a number of tests to determine the cause, location and length of the urethral stricture. These may include:
- Urethral imaging such as X-rays or Ultrasounds evaluate the length of the stricture
- A urinalysis inspects the appearance, concentration and content of your urine, looking for signs of infection, blood or cancer
- A urinary flow test calculates the strength, speed and amount of urine flow
- A pelvic ultrasound evaluates the length of the stricture, identifying the presence of urine in your bladder following urination
- A pelvic magnetic resonance imaging (MRI) — calculates whether your pelvic bone is affecting or is affected by your situation
- A retrograde urethrogram — uses X-ray images to check for injury and the integrity of the urethra, as well as the length and location of the stricture
- A cystoscopy inspects your urethra and bladder using a thin instrument fitted with a lens (cystoscope) to view these organs. When investigating urethral disease, inserting the cystoscope into the bladder is unnecessary as only the urethra is examined.
Treatment for a Urethral Stricture
A urethrotomy is usually carried out under general anaesthetic meaning you will be asleep for the operation and will not feel any pain during the procedure. The operation typically takes less than half an hour.
Once you are asleep following the anaesthetic, the strictures are opened up with a surgical blade with the use of a cystoscope passed down the penis. Your doctor will evaluate the stricture, and if the area appears to be open and easily accessible, there will be no additional incisions. Following the cut, your bladder will be completely emptied of urine and filled with an irrigation solution. A catheter will then be inserted into your bladder and used to drain the irrigation solution.
One the operation is complete, you will be moved to the recovery room where you will stay until you have woken from the anaesthetic.
In most cases, you can go home the same day following surgery provided there are no complications; however, you may be required to stay overnight if the surgeon feels this is necessary. Before leaving the hospital, ensure you inform your nurse or doctor about any pain or discomfort you are experiencing so they can provide you with appropriate advice and pain relief.
Due to the use of a general anaesthetic, you will be required to have another adult available to drive you home following the procedure.
You should be able to return to work a few days following your operation, with regular exercise helping you return to your daily activities as soon as possible. Ask your doctor for advice before exercising to ensure you are not doing too much, too soon. The majority of the recovery progress happens within the first 6 weeks following the operation, but improvement can continue for months.
You should refrain from sexual intercourse for a couple of weeks and avoid strenuous activities and intense exercise until your doctor says it is safe to do so.
The catheter put in place during the surgery will usually have to remain for a few days; the main purpose of this is to make sure space remains open and it heals that way.
It is important to avoid straining during bowel movements. To help avoid this, it is advised that you consume more fluids than usual and increase the fibre in your diet.
You will be instructed on how to manage the catheter in place and will be given a date to return to the hospital for the removal. Your doctor may prescribe antibiotics for you following the procedure to reduce the risk infection. It is important to maintain good hygiene during this time to keep the infection risk low.
Risks and Complications
There is always a certain amount of risk involved with surgery. Some of the most common complications linked to urethrotomy include:
Feeling a burning sensation or discomfort whilst urinating for a few days post-surgery. This is very normal and you do not need to worry.
It is normal to pass some blood when urinating. This should resolve itself within a week following your surgery. However, if it continues or you notice any clots, report it to your doctor immediately.
If you think you have a urinary tract infection following your surgery, you should report it to your doctor immediately. Signs of an infection include fevers and chills.
Recurrence of stricture
It is possible that your urethra will narrow or develop a stricture again, even after the operation. Additional surgery may be recommended following consultations with your doctor.
Further, uncommon and serious complications may include:
- Extreme bleeding
- Inflammation of the penis
- Incapability to pass urine
If any of these complications occur, you should immediately report it to your doctor.
There are certain factors that increase the risk of developing complications post-surgery, such as smoking. Smoking can seriously affect the wound-healing process and it is suggested that if you smoke, you give up before undergoing surgery in order to achieve the best results possible.
Other factors that can increase your risk of complications include bleeding disorders and blood-thinning medications. If you have a blood clotting condition or you are taking medication that reduces your body’s blood clotting abilities, it is important you tell your doctor.
Outlook after Urethrotomy
If you complain about symptoms such as pain when urinating, urinary tract infections, blood in urine, spraying urine, and incapability to fully empty your bladder, your doctor may suspect there is a narrowing in your urethra. A narrowing of the urethra can cause a slow flow of urine, often with dribbling, pain, bleeding and infection. A urethrotomy should relieve your symptoms.
At One Healthcare we can book you in to see a specialist Urology surgeon for an initial consultation, usually within 48 hours. Urethrotomy is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire.
You can use your private medical insurance or pay for your Urethrotomy treatment. We offer competitive, fixed price packages as well as the ability to spread your cost with the option of 0% finance. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at One Hatfield Hospital.
Why One Hatfield
- Modern purpose-built hospital opened in December 2017
- Fast access to diagnostics including MRI, X-ray and Ultrasound
- Private, spacious, en-suite rooms
- Specialist physiotherapy and nursing teams
- Little or no waiting time
- ‘Ultra clean air’ theatres
- Freshly prepared food
- Calm, dignified experience
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