Urethral Dilatation

Overview

Male urethral stricture disease is common and significantly affects both health care expenses and quality of life. The complexity of urethral stricture management is dependent on the stricture's features. Long-term results do not differ between internal urethrotomy and urethral dilatation, according to data; success rates range widely from 8 to 85%, with long-term success rates of 25 to 30%. For both of these procedures, males who have longer strictures, penile urethral strictures, multiple strictures, the presence of infection, or a history of previous treatments are at a higher risk of recurrence. Repeated urethrotomy is not clinically or financially beneficial for these patients, according to analysis. With most studies reporting success rates of 85-90%, surgical repair utilizing urethroplasty has higher long-term success rates. Various urethroplasty procedures have been used, depending on the position, length, and kind of stricture. An in-depth understanding of anatomy, pathophysiology, correct patient selection, and reconstructive procedures are necessary for successful therapy of urethral strictures.

 

What is Urethral Dilation?

Urethral dilatation, an internal urethral dilatation, is a surgical procedure used to treat urethral stricture disease. An outpatient procedure entails utilizing a urethral dilator or a surgical knife inserted through a cystoscope to widen a narrow urethra. Since urethral strictures in females are extremely uncommon, urethral dilatations are often solely performed on males.

 

Urethral Dilatation Purpose

Your doctor may think that you have a narrowing in your urethra (the tube that empties urine from your bladder) if your child complains of symptoms including pain when peeing, urinary tract infections, blood in the urine, spraying urine, and an inability to empty your bladder.

Determining if you have urethral stricture will be the next step. A diagnosis of urethral stricture illness can be made by:

• Simple physical assessment
• Ultrasound or X-ray of the urethra
• Retrograde urethrogram
• Urethroscopy
• Cystoscopy
• Postvoid residual volume (PVR)

Your doctor won't suggest getting a urethral dilatation until after this diagnosis has been made.

 

Urethral Dilatation Preparation

Healthcare professionals will probably request imaging tests and/or perform a cystoscopy to determine the size and severity of the stricture. To verify and make sure your child is in good health, he might also conduct some blood tests.

Urine will also be examined to make sure there are no bacteria present. The doctor might request a heart electrocardiogram (ECG) based on your child’s age and any existing heart issues he might have.

With a healthcare practitioner, you will go through your medical history as well as the procedure for the surgery and any potential dangers. Because your child might need to stop taking some medications a few days or weeks before your urethral dilatation, you should expect to discuss all medications and drugs your child is now using with your healthcare professional.

You should carefully read the consent form that you will be asked to sign. Additionally, be sure to clarify any parts or components of the form that are unclear to you.

You are encouraged to refrain from eating for at least six to eight hours before the time allotted for your urethral dilatation, and you are only permitted to consume clear liquids up to two hours before surgery because you will be given an anesthetic. Your healthcare practitioner should make sure that you understand everything.

Ask your healthcare practitioner how to take any daily prescriptions on the day of your procedure if you have any questions. Typically, the procedure lasts for 30 minutes.

 

What to Bring?

• It is advised that you bring loose-fitting underwear because you will probably be going home with a catheter in place to drain your bladder for one to several days after the treatment and to promote healing of the previous site of your urethral stricture.
• You should think about bringing dark underwear instead of light-colored underwear since light-colored underwear may make any post-operative bleeding appear and seem more serious.
• If at all feasible, bring a light meal that you can consume after the procedure because it is likely that you won't have eaten in several hours.
• It is advised to bring a case for your glasses or hearing aids if you wear them.

 

Urethral Dilation Procedure

Urethral dilation can be done in the operating room under sedation or general anesthesia, or it can be done at the doctor's office under local anesthetic. Both of these procedures are different from at-home urethral dilatation, which slows the recurrence of urethral strictures by using a urinary catheter. What to anticipate is as follows:

• Antibiotics will be administered to you before surgery to lower the risk of infection.
• You will be required to put on a hospital gown.
• There is a lubricating, numbing fluid put inside the urethra.
• The bladder is reached by inserting a flexible wire through the urethra.
• A series of plastic or metal tubes will be introduced using the wire as a guide to gradually stretch the stricture.
• The surgeon will then evaluate the stricture once more. There won't be a need for additional dilation to be made if it seems open and accessible.
• More dilation will be made if it is not adequately opened up after the initial one.
• Your bladder will then be emptied of pee and filled with irrigation fluid after that.
• Your bladder will be inserted with a catheter, which will be used to empty the irrigation fluid.
• If a catheter is left after the procedure, it normally stays there for 1-3 days.
• The recovery room is where you will stay till you are awake after being brought there.

 

Postoperative Recovery

Your condition will be observed while you are in the recovery area. At regular intervals, a nurse should check the following:

• Your vital signs, including your heart rate, temperature, pulse, and breathing.
• Your level of pain and how well the painkillers you have been given are working for you.
• The amount and ease with which you are passing urine.

Your blood may be supplied with fluids and painkillers (which are frequently unnecessary) via an intravenous (IV) drip. An oxygen mask may also be attached to you to aid with breathing. You will eventually be transferred to a ward in anticipation of your discharge once you are completely awake and at ease.

 

Urethral Dilatation Recovery

The majority of patients return home the same day as their operation, however, depending on the situation, you might be required to stay as an inpatient for an extra day. Many hospitals ask that you have another adult ready to drive or accompany you home following the surgery because anesthesia is involved. It is advised that you wait at least 24 hours following the surgery to move heavily due to the anesthesia's residual effects.

Your healthcare practitioner or attending nurse should be made aware of any pain or discomfort you may be experiencing before you leave so that they can put the best pain treatment system in place for you. It's common to feel some discomfort following the procedure, as well as intense urges to urinate and/or a burning sensation in your urethra.

The catheter inserted during the procedure will probably need to stay in for a few days. The main goal of this is to maintain the space's openness and allow it to heal naturally. You should anticipate the following in the meantime:

• Your healthcare professional will provide you with instructions on how to manage an existing catheter or perform self-catheterization.
• Additionally, your doctor will let you know when to come back to the clinic or hospital for removal.
• To lower your risk of developing an infection after surgery, your doctor can prescribe antibiotics for you. To further reduce the danger, you should practice proper hygiene.
• After a few days, you will be able to get around and probably go back to work.
• For a few weeks, you should refrain from having any sexual activity. The best person to advise you on how long you should refrain is your healthcare practitioner.
• Up until your practitioner gives you the all-clear, stay away from demanding tasks and intensive exercise.
• It's crucial to avoid straining while having a bowel movement. To avoid constipation, it is advised that you drink plenty of fluids and switch to a high-fiber diet for a while following the procedure. You might also need to take laxatives or stool softeners. You should talk to your healthcare physician about this.

 

Urethral Dilation Side Effects

You run the risk of experiencing some consequences after a urethral dilatation. Among the most typical ones are:

• Urethral pain. After surgery, it's typical to have some soreness or burning when peeing for a few days.
• Bleeding. You frequently give out some blood along with your urine. Within a week of your procedure, this ought to go away. Inform your healthcare practitioner if it continues or if you notice any clots.
• Infection. After surgery, you should contact your doctor right away if you think you could develop a urinary tract infection (UTI). Fever and chills are classic signs of an infection.
• Recurrence of the stricture. Your urethra may likely tighten or form a stricture once more. You could need to have a urethroplasty or another similar procedure, depending on the results of additional discussion with your healthcare practitioner.

Other unusual and serious consequences include:

• Excessive bleeding
• Increasing penile swelling
• Not being able to urinate

You need to tell your healthcare physician right away if any of these three occur.

Smoking is a significant factor that raises the chance of problems following surgery. Smoking can hurt how quickly a wound heals. You might benefit from starting nicotine replacement treatment before surgery to lower your risk of experiencing major problems. In any case, if you smoke, you should let your doctor know so they can advise you on the best course of action.

Bleeding problems and blood-thinning drugs are additional factors that can raise your risk of complications. Inform your healthcare provider if you suffer from a blood clotting disease or are taking any medications, such as aspirin, that may unintentionally or intentionally decrease your body's ability to clot blood.

 

Urethral Dilatation Follow-up

When it is time for the surgeon to remove the catheter, you will come back to the office or hospital as directed.

To determine how quickly and completely your bladder empties itself, a uroflowmetric study or post-void residual study (PVR) may be carried out.

You will be asked to urinate in a device or special toilet so that the scientists can measure your urine output, quality, flow rate, and time required to urinate. You will be given the go-ahead to return a few weeks later for another check-up so that a urinalysis and possibly another uroflowmetric testing can be done.

It's crucial that you discuss any concerns or disturbing symptoms with your healthcare physician at these follow-up visits.

 

Urethral Dilation Success Rates

Given the low long-term success rate of urethral dilatation and the significant likelihood that the urethral stricture will recur, many patients who have had one will still need additional procedures. According to a medical study, success rates for urethral dilatation are between 70 and 80 percent in the short term (less than 6 months). However, after a year, this decreases and the rates of recurrence begin to converge at 50-60%. Recurrence increases dramatically to between 74 and 86 percent after five years.

In cases when open surgery (urethroplasty) would be additional treatment or as a management option before deciding if open surgery is necessary, urethral dilatation is still recognized in healthcare as a reliable choice for treating urethral strictures.

 

Urethral Dilation Alternatives

Urethroplasty and urethrotomy are alternatives to urethral dilation. To stretch out the stricture and broaden the narrowing, thin rods (dilators) of varying sizes are inserted into your urethra during dilatation. When the stricture is too lengthy to be addressed with less invasive cystoscopy with urethral dilatation, urethroplasty is the reconstruction or replacement of a narrow urethra by open surgery. The treatment your doctor will advise you to have will primarily rely on how severe your urethral stricture is and how well any prior treatments you may have had to address it have gone.

 

Conclusion

The medical system incurs significant morbidity and costs as a result of the widespread urethral stricture disease. Imaging techniques like retrograde urethrography are used to diagnose strictures and arrange their intended correction. To treat strictures, a variety of techniques are available, such as urethral dilatation, internal urethrotomy, and urethroplasty. The long-term success rates documented for surgical repair with urethroplasty are significantly lower than those for urethral dilatation, which appear to have similar success rates. Given that the failure rate of internal urethrotomy rises significantly with repeated treatments, cost-effectiveness analysis encourages the adoption of urethral dilatation as soon as possible (after one failed procedure). Several methods, including anastomotic, flap, and graft procedures, can be used to reconstruct the urethra. To have the best chance of success, the strategy used should be based on the size, location, and nature of the restriction. There are still concerns about the relative effectiveness of these methods and how to manage complicated strictures; more research is required to resolve these problems.