What are the indications for an optical urethrotomy?
An optical urethrotomy may be recommended when scarring has narrowed the urethra and is affecting how you pass urine. Typical symptoms include:
- A slow urine stream, spraying, straining or a sense of incomplete emptying
- Recurrent urine infections
- A stricture confirmed on flow tests or camera inspection of the urethra
An optical urethrotomy is often chosen as an initial, minimally-invasive treatment because it avoids open reconstructive surgery. It is important to understand however that endoscopic treatments do not always cure a stricture permanently. Some men need repeat treatment, with a minority requiring reconstructive surgery.
What are the alternatives?
- Observation — If the stricture is mild and not too troublesome.
- Urethral or meatal dilatation — Gently stretching the narrowing with plastic or metal sounds, or balloon systems such as Optilume®.
- Reconstructive surgery — Urethroplasty or meatoplasty, which offers a more durable cure for suitable strictures.
What happens before surgery?
You will be asked to attend for a pre-operative assessment approximately 2-3 weeks before surgery, where blood tests and an ECG are typically performed to ensure the procedure takes place with minimal risk. Most patients should continue regular medication, although certain drugs should be stopped prior to surgery. Please tell the team if you take blood thinners or have any implants, a pacemaker or a history of MRSA.
On the day of surgery you should avoid eating for six hours before, and drink only clear fluids within 2 hours of the procedure. You will be given a gown and compression stockings to wear, your consent will be confirmed, and an anaesthetist will discuss your anaesthetic and pain relief.
What does the procedure involve?
- Performed under general anaesthetic under antibiotic cover.
- There are no cuts in the skin - the whole procedure is done through the urethra.
- A fine telescope is passed along the urethra to the narrowed segment and the stricture is opened with a small internal knife.
- The remaining urethra, prostate and bladder are then inspected for any other abnormalities.
- A catheter is usually left in place for 2-3 days.
- You may be taught to gently dilate your own urethra afterwards to help keep it open - you will be advised if this is necessary.
What are the side-effects?
- Mild burning or bleeding when passing urine (almost all patients).
- Recurrence of the stricture needing repeat or alternative treatment (30-50%).
- A urine infection needing antibiotics (10-20%).
- A false passage in the urethra needing temporary insertion of a suprapubic (abdominal) catheter (1-2%).
What happens after surgery?
Before discharge you will be shown how to manage and remove your catheter at home. If self-dilatation is recommended, an appointment is made 2-3 weeks after surgery to teach you the technique. You will receive a discharge summary, copied to your GP, and an outpatient appointment 6-8 weeks after surgery. You should attend this outpatient appointment 30 mins beforehand with a full bladder so we can obtain flow studies to measure the improvement in your urinary flow.
Patient information leaflet
Read the British Association of Urological Surgeons (BAUS) leaflet: Optical urethrotomy and urethral dilatation.
View the BAUS leaflet
Patient information video
Watch the YouTube video: How to remove your Foley catheter at home
Watch the video