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.