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URETHRAL STRICTURE
Urethral dilatation is indicated for urethral stricture, a
problem which is common in certain parts of the world.
Technique
| 1 |
Administer
appropriate analgesia and sedation before beginning
the procedure and start antibiotic treatment, to be
continued for three days. Carefully clean the glans
and meatus, and prepare the skin with a bland
antiseptic. Instil lidocaine gel into the urethra (optional) and retain it for 5
minutes. Drape the patient with a perforated towel to isolate the penis. |
| 2 |
In
the acute stricture, begin by introducing a small
filiform; leave it in the urethra and continue to
insert filiforms until one passes the stricture.
Then progress to dilatation with medium-size followers
and gradually work up
in size (Figure 9.21).
For a post-inflammatory stricture that starts
in the anterior urethra, always introduce a straight bougie
first; this will minimize the risk of urethral damage (Figure
9.22).
After the acute stricture is dilated with filiforms and followers,
bouginage can be undertaken at regular intervals, using metal
bougies. Perform dilatation with straight bougies of increasing
size, and finally
introduce a curved bougie (Figure 9.23). Remember that the
small sizes of metal bougies are the most likely to lacerate
the urethra. Therefore, in this situation, filiforms and
followers should be used.
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| 3 |
Introduce a curved bougie in three stages:
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Bring the bougie parallel to the crease
of the groin and hold the penis taut (Figure
9.24) |
| • |
While raising the taut penis to the midline towards the patient’s abdomen,
slip the bougie into the posterior urethra and let it progress by its own weight
(Figure 9.25) |
| • |
Finally, bring the penis down to the midline, horizontally
between the patient’s legs, as the curve of
the bougie carries it up the posterior urethra and
over the neck of the bladder (Figure
9.26). |
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| 4 |
Initially, dilate the patient’s urethra at least
twice a week, using two or three sizes of bougie successively
at each session. Begin with the smallest sizes (for example,
12) and stop at about 24 Ch. If there is urethral bleeding,
skip a session to give the mucosa time to heal. Perform
follow-up dilatation:
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Weekly for 4 weeks |
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Twice monthly for 6 months |
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Every month thereafter. |
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Possible
complications
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Trauma – bleeding
or creation of a false passage |
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Bacteraemia |
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Septicaemia
and septic shock. |
Minimize complications by asepsis and the use of antibiotics.
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