What Is a Urethrotomy?

Urethrotomy, also known as direct vision internal urethrotomy, is a surgical procedure used to treat urethral stricture disease. It is an outpatient surgery that involves using a urethrotome or a surgical knife passed through a cystoscope to widen a narrowed urethra. Urethrotomies are generally only performed on men, as urethral strictures in women are very, very rare.

Purpose

If you complain about symptoms like pain when urinating, urinary tract infections, blood in urine, spraying urine, and inability to fully empty your bladder, your healthcare provider may suspect that there’s a narrowing in your urethra (the tube that lets out urine from your bladder).

The next step will be to confirm if you have urethral stricture disease. Urethral stricture disease can be diagnosed by:

• Simple physical examination
• Urethral X-ray or ultrasound
• Retrograde urethrogram
• Urethroscopy
• Cystoscopy
• Postvoid residual (PVR) volume

It’s only after this diagnosis has been made that your healthcare provider will recommend you undergo a urethrotomy.

Risks

The long-term success rate of urethrotomies is pretty low and many people who have one will still have to undergo subsequent surgeries as there is a high risk that the urethral stricture will reoccur. A medical study reports that in the short term (less than 6 months), success rates for urethrotomies are about 70–80 percent. However, after one year, this goes downwards and the rates of recurrence start to approach 50–60 percent. At the 5-year mark, recurrence shoots up to about 74–86 percent.

Alternative Procedures

Alternative procedures to a urethrotomy are dilation and urethroplasty. Dilation involves inserting thin rods (dilators) of increasing size into your urethra to stretch out the stricture and widen the narrowing. Urethroplasty is the reconstruction or replacement of a narrowed urethra by open surgery, generally when the stricture is too long to be treated with less invasive cystoscopy with urethrotomy. What your healthcare provider will recommend you undergo largely depends on the severity of your urethral stricture as well as the success or otherwise of previous procedures you may have undergone to treat it in the past.

Before the Surgery

It is likely that your healthcare provider will order imaging tests and/or perform a cystoscopy in order to gauge the length and severity of the stricture. He may also order some blood tests to be done to check and ensure that you’re in a good state of health.

A sample of your urine will also be tested to ensure that there are no bacteria in it. Depending on your age and any pre-existing heart conditions you may have, your healthcare provider may order a heart electrocardiogram (ECG).

You will discuss your medical history with your healthcare provider and you’ll also discuss how the surgery will be performed and its possible risks. You should expect to discuss all medication and drugs you're currently taking with your healthcare provider because you may need to stop taking them some days or weeks before your urethrotomy.

Expect to sign a consent form, which you should read carefully. Also, make sure to ask questions about any section or part of the form you are unclear about.

How to Prepare

Because you’ll be given anesthesia, you are advised not to eat for at least six to eight hours before the time allocated for your urethrotomy, and you can only drink clear liquids up to two hours before surgery. All of this should be clarified by your healthcare provider.

If you have any medications you take daily, you should ask your healthcare provider how you should take them the day of your operation. The surgery generally takes about 30 minutes.

Things to Bring Along

• It is advisable that you carry along loose-fitting underwear, as you’ll likely be returning home with a catheter in place to promote healing of the prior urethral stricture site and to drain the bladder for one day to multiple days after procedure..
• To help deal with anxiety, you should consider carrying along dark-colored underwear as opposed to lightly colored ones that may exaggerate the look and seriousness of any post-operative bleeding.
• If it’s possible, take along a lean meal that you can eat after the surgery, as you likely will not have eaten for many hours at that point.
• If you use glasses or hearing aids, it’s advisable to bring a case for them along.

During the Surgery

A urethrotomy is usually performed under general or spinal anesthesia. In special cases, local anesthesia may be used. You can expect the following:

• You’ll be given pre-operative antibiotics to reduce the risk of infections.
• You’ll be asked to change into a hospital gown.
• You will be directed to lie on a cystoscopy table in the operating room. You will most likely assume a dorsal lithotomy position—you’ll lie on your back with your thighs spread apart and your knees raised and pulled back.
• Once you’re asleep and fully under anesthesia, the surgeon will insert a urethrotome or cystoscope with a surgical knife attached into your urethra.
• The strictured area will be opened up in specific areas with the cutting blade or knife.
• The surgeon will then reassess the stricture. If the area appears to be open and easily accessed, there’ll be no need for further cuts to be made.
• If it’s still not sufficiently opened up, more incisions will be made.
• After that is done, your bladder will be completely emptied of urine and filled with irrigation fluid.
• A catheter will be put in place in your bladder and used to drain the irrigation fluid.
• You will then be transferred to the recovery room, where you’ll remain until you’re awake.

In the Recovery Room

While you’re in the recovery room, your condition will be monitored. You can expect a nurse to check the following at regular intervals:

• Your vitals—blood pressure, temperature, pulse, and respiration rate.
• The severity of pain you’re feeling, as well as the effectiveness of the pain relief medication given to you.
• How much urine you’re passing and how easily you're doing so.

You may be given an IV (intravenous) drip through which pain medication (often not needed) and fluids will be passed into your bloodstream. You may also be fitted with an oxygen mask to help you with breathing. Eventually, when you’re fully awake and comfortable, you’ll be moved to a ward pending your discharge.

After the Surgery

Most people go home the same day as the surgery, although depending on the circumstances, you may be asked to stay as an inpatient for a day. Because of the anesthesia involved, many hospitals require that you have another adult available to drive or accompany you home after the surgery. Residual effects of the anesthesia make it advisable that you don't drive or operate any heavy equipment for at least 24 hours after the procedure.

Before you leave, you should inform your healthcare provider/attending nurse about any pain or discomfort you may be feeling so that they can implement the most suitable pain relief system for you. You may experience some discomfort after the surgery and/or a burning sensation in your urethra, as well as strong urges to pee—this is normal.

Recovery

The catheter put in place during the surgery will likely have to remain for some days. The primary purpose of this is to keep the space open and let it heal that way. In the meantime, you can expect the following:

• Your healthcare provider will instruct you on self-catheterization or how to manage the one already in place. Your practitioner will also tell you when to return to the office or hospital for removal.
• Your healthcare provider may prescribe antibiotics for you post-operation to reduce the chances of you getting an infection. On your part, you should maintain good hygiene to further lower the risk.
• You’ll be able to move around and will likely be able to return to work after some days.
• You should abstain from sexual intercourse for a couple of weeks. Your healthcare provider will be in the best position to tell you how long exactly you should abstain.
• Avoid strenuous activities and intense exercise until your practitioner gives you the go-ahead.
• It is important that you do not strain during bowel movements. Because of this, it’s advisable that you consume a lot of fluids and adopt a high fiber diet for a while after the surgery, as this will help prevent constipation. You may also need to take stool softeners or laxatives. This should be discussed with your healthcare provider.

Possible Complications

There are certain complications that can occur after you undergo a urethrotomy. Some of the most common ones are:

• Urethral pain: It’s normal to feel a burning sensation or discomfort when you’re urinating for a few days post-surgery.
• Bleeding: It's common that you’ll pass out a bit of blood with your urine. This should resolve itself within a week after your surgery. If it persists or you start to see clots, report it to your healthcare provider.
• Infection: If you suspect you have a urinary tract infection after your surgery, you should immediately report it to your practitioner. Telltale signs of an infection are fevers and chills.
• Recurrence of stricture: It is highly possible that your urethra will narrow or develop a stricture again. Depending on the outcome of further consultation with your healthcare provider, you may have to undergo another similar surgery or a urethroplasty.

Some otherwise uncommon and serious complications are:

• Excessive bleeding
• Swelling of the penis
• Inability to pass urine

If any of these three happen, you should immediately report it to your healthcare provider.

There are certain factors that increase the risk of complications post-surgery, and a major one is smoking. Smoking can negatively affect the wound-healing process. It may be helpful for you to begin nicotine replacement therapy before your surgery in order to reduce your risk of developing serious complications. In any case, if you smoke, you should definitely disclose it to your healthcare provider, who will then recommend the best course of action.

Other things that can increase your risk of complications are bleeding disorders and blood-thinning medications. If you have a blood clotting disorder or you are taking medication that deliberately or inadvertently (like aspirin) reduces your body's blood clotting abilities, be sure to tell your healthcare provider.

Follow Up

You will return to the office or hospital as instructed when it is time for the catheter to be removed by the surgeon.

A uroflowmetric study or post-void residual study may be performed to check how fast and completely your bladder empties itself. The study is done by asking you to urinate in a machine or special toilet that measures your urine output and quality, flow rate, and the time it takes you to urinate. You will be instructed to return after some weeks for another check-up where another uroflowmetric study may be performed, as well as a urinalysis.

During these follow-up visits, it’s important that you disclose concerns or any worrying phenomenon you may be experiencing to your healthcare provider.

Coping With Anxiety

The first thing you need to know is that it's perfectly normal for you to feel anxious, worried, or even fearful about your upcoming surgery. Undergoing surgery is likely a completely new situation for you and it’s natural to require some emotional and practical support for it.

Fortunately, a urethrotomy is a simple, usually outpatient, surgery with minimal chances of serious complications. You’ll recover fast and be back on your feet in no time.

A good way to deal with your anxiety and allay your fears is to extensively discuss it with your healthcare provider. Ask questions about the procedure and communicate your worries to them. A thorough explanation of the surgery and what you should and shouldn’t expect will likely put you at ease. You should also speak to your friends and family about it if you feel like that will help. Additionally, you can find out if your hospital offers any special support for this sort of thing, perhaps by having counselors or social workers available to speak with you.

A Word From Verywell

Before you consent to have this surgery, or indeed, any other kind, you should discuss your options extensively with your healthcare provider. Feel free to seek a second medical opinion if you’re still unsure about what route to go. And lastly, try to have realistic expectations of the outcome of the surgery.