Urethrotomy

Urethral Stricture

Urethral stricture

Cystoscopic view

Cystoscopic view of urethral stricture


Urethral strictures can occur from an infection or more commonly, injury during catheterisation or endoscopic surgery. Urethrotomy is a procedure to divide the scar tissue that is causing the narrowing.
The diagnosis is easily made from the uroflow which show a "box-like" pattern.

Urethrotomy

Uroflow pattern of urethral stricture


The location and length of the stricture can be determined from an ascending urethrogram xray.

Ascending Urethrogram

Ascending urethrogram


The surgery is done under general anaesthesia using a knife loaded onto a cystoscope (optical urethrotome) with or without serial dilators.

Urethrotome instrument

Urethrotome instrument to cut the stricture

Urethrotomy

Cystoscopic appearance before & after urethrotomy


The problem with urethra strictures is recurrence. To prevent this, a catheter may have to be left in for a period of time. Patients may also have to do daily self-dilatation for a period of 1 to 3 months. Frequent recurrences would require urethroplasty surgery which is more complicated to do.

Complications include:

  • bleeding. If active, compression of the penis will be needed. The bleeding can last up to a week.
  • urine infection. This will cause fever and painful / frequent urination.
  • recurrence of stricture. This tends to occur within 2 to 3 weeks. If it does, then repeat surgery is needed. Daily self-dilatation with 14F Nelaton catheter can help prevent this.

Desired outcomes:

  • minimal bleed
  • no recurrence