What is Optical Internal Urethrotomy? How does it help?

The urethra is a tube that enables the urine to flow from the bladder to be expelled from the body. In general conditions, the urethra is wide enough to allow the urine to flow through smoothly, but in cases where it narrows, it can restrict the flow of urine out of the body creating a condition called Urethral stricture. 

Urethral stricture is a very common problem which can block or reduce the flow of urine, causing severe problems and discomfort. Severe complications include urinary tract infections, renal insufficiency and urinary retention, etc. Thus, urethral stricture needs to be treated timely and effectively before the condition worsens to cause permanent health conditions. Among other treatment options, Optical Internal Urethrotomy is often a preferred choice of many doctors because the procedure is minimally invasive, where the stricture is treated with a laser without making any incisions. Optical internal urethrotomy normalizes the flow of urine and removes all difficulties and discomfort experienced during urination. 

The surgery aims to treat urethral strictures by removing the body tissues in the urethra to release it. The surgery will be performed by inserting a telescope through the urethra and using internal knife or laser to cut any narrowing caused due to stricture; the process does not involve making any incisions or stitches. Post the procedure, the doctor will ask the patient to insert a catheter into the bladder for 24 to 48 hours. That said, the treatment of urethral stricture via optical internal urethrotomy is often the first choice of many doctors; however, the success rates of the procedure are low in terms of higher chances of recurrence. 

Causes of Urethral Stricture

  • Urethral strictures can be caused due to multiple reasons such as:
  • Inflammation of tissues
  • Presence of scar tissue
  • Straddle injury causing trauma to the groin area
  • Trauma or injury to the urethra or pelvis
  • Sexually transmitted infections
  • Exposure to radiation
  • Urethra or prostate cancer
  • Catheter insertion
  • Pelvic fractures
  • Prostate surgeries
  • Consistent urinary tract infections

Urethral stricture is highly common in men and highly uncommon in women.

Symptoms of Urethral Stricture

Some common symptoms that indicate urethral stricture are:

  • Lesser urine frequency
  • Incomplete emptying of the bladder
  • Spraying pattern of the urine
  • Pain or difficulty in urinating
  • Increased urge to urinate
  • Infection of the urinary tract
  • Weak flow of urine
  • Lower volume of urine
  • Lack of control on urination
  • Pain in the pelvic or lower abdominal area
  • Discharge from the urethra
  • Blood in semen or urine
  • Foul-smelling, dark-colour urine
  • Inability to urinate

When any of these symptoms are detected, a diagnosis to check for urethral stricture should be made. Post confirmation of condition, appropriate treatment method such as an optical internal urethrotomy is undertaken.

Preparation and Procedure of Optical Internal Urethrotomy

The doctor will confirm the symptoms through some diagnostic tests and also determine the severity of the problem. Some tests that will be conducted for analysis include measuring urine discharge, assessing hr chemical properties of the urine, cystoscopy, and measuring the urethra to detect narrowing. These tests will be followed by X-rays and ultrasounds.

Once the condition and the severity of the problem are clear, the doctor will place the patient under the influence of anaesthesia, and then insert a cystoscope – a thin, flexible tube into the urethra. This tube will form a passage to insert other surgical instruments that will help remove the stricture or vaporise it with laser. 

Post the procedure, the doctor will make the patient aware of self-care and preventive measures to avoid infection. Moreover, the patient will be guided on how to monitor for signs of infection and when to call for medical help. The doctor will also recommend some antibiotics to speed the recovery as well as reduce pain. Certain precautions such as no physical exertion, recommended diet, water intake, etc. will be advised. The patient will also be asked to refrain from driving for a week. 

Risks associated with an Optical Internal Urethrotomy

The risks of each case depend on the patient’s condition and the health factors. That said, some common risks include:

  • Infection in the urinary tract
  • Infection at the site of the operation
  • Wound dehiscence
  • Recurrence of the stricture
  • Extensive bleeding
  • Blood clots
  • Damage to urethra
  • Long operative time

Moreover, an optical internal urethrotomy is not suitable for long and post-inflammatory strictures. Also, in cases where the stricture is longer than 2 cm, additional operative time will be required, as well as the procedure might be conducted in two separate sessions.

Advantages of an Optical Internal Urethrotomy

An optical internal urethrotomy is often the first choice of many doctors because of the following advantages over other methods to treat urethral stricture. Some of the ways in which this procedure helps are:

  • Faster recovery
  • Minimally invasive
  • Barely any scars
  • Low risk of infection

In all, optical internal urethrotomy is a very common and widely opted for procedure to treat urethral stricture; however, one must consult the doctor – understand the method and also evaluate all pros and cons, before deciding on the method. 

Understand Uterine Fibroid Embolisation (UFE)

Uterine fibroid embolisation (UFE) is a minimally invasive procedure to treat fibroid tumours – non-cancerous growths – of the uterus – that cause excessive menstrual bleeding, pain and a lot of pressure on the bladder. Uterine fibroid embolisation is also known as uterine artery embolisation and aims to block the blood vessels supplying blood to the fibroid, causing it to starve, shrink and eventually die. The procedure is done through a flexible tube called catheter to inject tiny particles known as embolic agents into the arteries of the uterus – that supply blood to the uterus and the fibroids.

Uterine fibroid embolisation serves as an alternative to surgery and aims to destroy the fibroid tissue to ease serious symptoms in some women such as:

  • Excessive menstrual bleeding
  • Pelvic pain
  • Swelling in the abdomen

Risks Involved in Uterine Fibroid Embolisation

Uterine fibroid embolisation is a safe procedure, especially for women who are not willing to undergo surgery to treat uterine fibroid embolisation. The risks of complications in the procedure are rare, but some general risks involve include:

  • Infection
  • Damage to the other organs
  • Possible issues in a future pregnancy

Most fibroids can be treated via the uterine fibroid embolisation; however, if the size of the fibroid is too large, another treatment option may have to be explored.

Reasons to avoid Uterine Fibroid Embolisation

Uterine fibroid embolisation may not be the ideal choice of treatment in cases such as below:

  • Existing pregnancy
  • Existing chances of pelvic cancer
  • Chronic pelvic infection
  • Vascular disease
  • Allergies

Procedure and Recovery from Uterine Fibroid Embolisation

To prepare for the procedure, the doctor will advise discontinuation of certain medicines, as well as not eating anything post-midnight or per time suggested on the say the day of the surgery. To initiate the surgery, the doctor will put the patient under the influence of anesthesia to reduce pain; then a small incision over the femoral artery in the groin is made to insert a catheter into the artery. The catheter is mounted with a high-definition camera and light that guides the catheter to the uterine arteries. Upon reaching the artery, a contrast fluid such as a dye is inserted into the uterine artery that makes the branches visible on the monitor; it also lights up the fibroids brighter as compared to other tissues –it easier to spot and treat.

Upon identifying the fibroids, the doctor then injects small particles of plastic or gelatin into the blood vessel supplying blood to the fibroids; these particles cause blockage and restrict the supply of blood to the fibroid, leading to starvation and eventually death of the fibroid tissue.

Post the surgery, the patient is kept under observation for a few hours to ensure no complications arise. The patient is supposed to lie flat for a few hours to avoid bleeding at the femoral artery site. Once the anesthesia fades, the patient will experience pain which can be easily managed with pain relievers as prescribed by the doctor. Some people might experience post-embolisation syndrome, such as:

  • Mild fever
  • Pain
  • Fatigue
  • Nausea
  • Vomiting

These symptoms develop 48 hours after the uterine fibroid embolisation and tend to fade away on their own in a week’s time or so. Any complications must be consulted with the doctor. The hospital stay of the surgery is less and the recovery time if fast.

On the next day of the procedure, most women are discharged from the hospital with certain medicines to take for the pain and smooth healing. The pain will subside in a day to two following the procedure.

However, a woman should carefully monitor the recovery process and should seek medical help, in case of conditions such as:

Vaginal discharge: Watery vaginal discharge is very common post the procedure; however, it is expected to fade on its own without any treatment. In case it does not, call for medical help.

Infection: Any signs of infection should be critically monitored such as chills, fever, pain, etc. Moreover, a follow-up meeting with the doctor should be set four weeks after the procedure to check for any signs of infection. Also, three months after the procedure, the doctor might advise an MRI to assess shrinkage or changes in the fibroids or the uterus.

Results of Uterine Fibroid Embolisation

Uterine fibroids embolisation is helpful in removing fibroids and reducing the resultant pain, pressure on the bladder, swelling, etc. In all the procedure provides the following results:

Relief from symptoms: The procedure is very effective and safe, and tends to provide relief from severe patients within 3 months of the surgery. Also, over the following five years post the treatment, it continues to reduce symptoms including heavy bleeding, urinary incontinence and enlargement of the abdomen.

Menstruation: Menstrual cycles continue to come normally post the procedure; however, in case the period is missed, it will resume normal course within a few months. Some women aged 45 or more have a risk of entering menopause after the procedure.

Fertility: The procedure is likely to have negative effects on fertility among women. Though menopause is rare post the procedure, yet certain damage caused to the ovaries can make pregnancy difficult. This also increases pregnancy complications involving placenta. However, even after the procedure, women have had normal pregnancies and no problems.

In all, uterine fibroid embolisation is an effective, safe and barely complicated method to treat fibroids in the uterine; also, its advantages outweigh its disadvantage. 

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