What is this?
Stretching of the urethra or the urethral opening for narrowing resulting in a poor urinary stream
What alternatives are there?
Surgical enlargement of the urethral opening, optical urethrotomy, self-dilatation, observation
What to expect before procedure
You will usually be admitted on the same day as your surgery although some patients require admission on the day before surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.
What happens during the procedure?
Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively. The urethra or urethral opening is stretched using metal or plastic dilators after passing local anaesthetic jelly to numb and lubricate the passage.
After the procedure
The urethra or the opening of the urethra are stretched using a variety of instruments. It may be necessary to insert a catheter in the urethra (water pipe) after the procedure. Average hospital stay is 1 day unless a catheter is inserted when it is 2 days.
Potential side effects
When you leave hospital, you will be given a draft discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge. When you get home, you should drink twice as much fluid as you would normally for the next 24-48 hours to flush your system through. You may find that, when you first pass urine, it stings or burns slightly and it may be lightly bloodstained. If you continue to drink plenty of fluid, this discomfort and bleeding will resolve rapidly.
What to look out for
If you develop a fever, severe pain on passing urine, inability to pass urine of worsening bleeding, you should contact your GP immediately.
It is likely that you will need to learn to pass a slippery catheter or spigot into the penis to help the widened urethra stay open. You will be instructed in this technique by the Specialist Nurses in the clinic, approximately one week after your discharge from hospital. Depending on the underlying problem, an outpatient appointment, further treatment or another admission may be arranged before you leave the hospital. Your Consultant or named nurse will explain the details of this to you.
There is no specific research in this area at the moment but all operative procedures performed in the department are subject to rigorous audit at a monthly Audit & Clinical Governance meeting.