What Is An Urethrotomy?
An urethrotomy is an operation to treat a narrowing of your urethra (tube that carries urine and semen to the tip of your penis). The narrowing (stricture) is usually caused by scar tissue forming after inflammation, an infection or injury. The operation involves cutting the scar tissue to make your urethra wider.
Dr Vasudevan has recommended an urethrotomy. However, it is your decision to go ahead with the procedure or not.
This document will give you information about the benefits and risks to help you to make an informed decision. If you have any questions that this document does not answer, ask Dr Vasudevan.
What Are The Symptoms Of A Narrowing Of Your Urethra?
Your urethra is about 18 centimetres long (about 7 inches). A narrowing can happen anywhere along the length of your urethra. This results in the following symptoms.
- The need to pass urine more often.
- Sudden urges to pass urine.
- Having to wait longer than usual before starting to pass urine.
- Slow flow of urine, often with dribbling.
- The urine stream forking or spraying.
- The feeling of not having fully emptied your bladder.
- A narrowing can also make you prone to infections, which can keep coming back.
What Are The Benefits Of Surgery?
You should get a better flow of urine and improved bladder emptying, and not need to pass urine as often during the night. You should also be less prone to infections.
Are There Any Alternatives To An Urethrotomy?
There is no medication available to treat a narrowing of your urethra and it will not get better. It is possible to try to treat a narrowing using the following techniques.
Balloon dilatation – This involves inflating a balloon in your urethra to make it wider.
- Dilators – This involves placing small metal rods, called sounds, into your urethra to stretch the narrowing.
However, these options have poor long-term results.
For most men the aim of an urethrotomy is to improve their lifestyle by relieving the symptoms. However, for a few men an urethrotomy is essential and Dr Vasudevan will tell you if this is the case.
More complicated narrowings sometimes need open surgery, where the narrowing is repaired using plastic-surgery techniques. This involves using tissue from other areas of your body such as the lining of your mouth.
What Will Happen If I Decide Not To Have The Operation?
Symptoms can come and go but often the symptoms get worse.
If the narrowing is severe, you will find it difficult to pass urine at all. You may get bladder stones and even develop kidney failure.
What Does The Operation Involve?
The healthcare team will carry out a number of checks to make sure you have the operation you came in for. You can help by confirming to Dr Vasudevan and the health team your name and the operation you are having.
The operation is performed under a general or spinal anaesthetic. Your anaesthetist will discuss the options with you and recommend the best form of anaesthesia for you. You may be given antibiotics during the operation to reduce the risk of infection. The operation usually takes less than 30 minutes.
Dr Vasudevan will pass a rigid telescope (cystoscope) into your urethra to examine the narrowing (see figure 1 above).
Dr Vasudevan will usually pass another instrument call an urethrotome down through the cystoscopy. The urethrotome has a blade, which Dr Vasudevan will use to make a cut in the scar tissue to make your urethra wider (see figure 2). Dr Vasudevan may also use a laser to cut the tissue open.
Dr Vasudevan will then pass the cystoscope into your bladder to check for any problems. Dr Vasudevan will place a catheter (tube) in your bladder. This will allow you to pass urine easily, and your bladder to be washed out with fluid to prevent blood clots.
Figure 2 . An urethrotome cutting through the narrowing
What Should I Do About My Medication?
Let Dr Vasudevan know about all the medication you take and follow his advice. This includes all blood-thinning medication as well as herbal and complementary remedies, dietary supplements, and medication you can buy over the counter.
What Can I Do To Help Make The Operation A Success?
If you smoke, stopping smoking several weeks or more before the operation may reduce your risk of developing complication and will improve your long-term health.
Try to maintain a healthy weight. You have a higher risk of developing complication if you are overweight.
Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health.
What Complication Can Happen?
Dr Vasudevan will try to make the operation as safe as possible but complications can happen. Some of these can be serious and can even cause death (risk: 1 in 400). You should ask Dr Vasudevan if there is anything you do not understand. Dr Vasudevan may be able to tell you if the risk of a complication is higher or lower for you.
Complications of anaesthesia
Your anaesthetist will be able to discuss with you the possible complication of having an anaesthetic.
General complications of any operation
- Pain is usually only mild and easily controlled with simple painkillers such as paracetamol.
- Bleeding during or after the operation. Any bleeding is usually little. If you continue to pass blood clots and blood in your urine, contact your Dr Vasudevan.
- Infection. If you need to pass urine often and pass only small amounts with a great deal of discomfort, you may have an infection. If your symptoms continue to get worse, contact Dr Vasudevan. You may need treatment with antibiotics.
Specific complications of this operation
- Difficulty passing urine, if blood clots have moved up into your bladder, or if any pain is preventing you from emptying your bladder. You will need a catheter for a few days.
- A swollen penis, if the stricture was in the part of your urethra in your penis. This usually settles quickly.
- Narrowing of another part of your urethra caused by scar tissue forming. This is unusual.
How Soon Will I Recover?
After the operation you will be transferred to the recovery area and then to the ward.
You should be able to go home the same day or the day after. However, Dr Vasudevan may recommend that you stay a little longer.
If you do go home the same day, a responsible adult should take you home in a car or taxi and stay with you for at least 24 hours. Be near a telephone in case of an emergency.
The area where the tissue was cut will be raw for a few days, so the first few times you pass urine you will feel a stinging pain. Drink plenty of water as this will keep your wound clean and reduce the risk of blood clots.
If you are worried about anything, in hospital or at home, contact Dr Vasudevan. He will be able to reassure you or identify and treat any complication.
Returning to normal duties
Do not drive, operate machinery or do any potentially dangerous activities (this includes cooking) for at least 24 hours and not until you have fully recovered feeling, movement and co-ordination. If you had a general anaesthetic or sedation, you should also not sign legal documents or drink alcohol for at least 24 hours. If you continue to pass blood or find it difficult to pass urine, contact Dr Vasudevan. You may need to come back to hospital to have a blood clot removed using a catheter.
Even though there is no cut on the outside of your penis, you will have had an operation and it is normal to be tired for a few days. Do not do strenuous exercise during this time. You should be able to return to work after a few days.
Regular exercise should help you to return to normal activities as soon as possible.
Sometimes a narrowing can happen again and symptoms will come back (risk: 3 to 5 in 10). Most men make a good recovery, with a large improvement in their symptoms. Progress is most rapid in the first six weeks but improvement can continue for many months, particularly if your bladder has become overactive.
A narrowing of your urethra can cause a slow flow of urine, often with dribbling, pain and infection. An urethrotomy should relive your symptoms. Surgery is usually safe and effective but complication can happen. You need to know about them to help you to make an informed decision about surgery. Knowing about them will also help to detect and treat any problems early.