Internal

Urethrotomy
Ryan Akhmad Adhi
Saputra

Campbells Walsh Urology

10th Ed.2012

Introduction

Internal urethrotomy refers to any

procedure that opens the stricture by
incising it transurethrally.

The urethrotomy procedure involves

incision through the scar to healthy
tissue to allow the scar to expand
(release of scar contracture) and the
lumen to heal enlarged.

(Ross and Wilson, anatomy

and physiology, 2004)

Anatomically the urethra is divided into 2 parts :

urethra

posterior urethra and

anterior urethra

Urethra equipped with the internal urethral sphincter and external

urethral sphincter

Length of female urethra approximately 3-5 cm, male urethra is

approximately 23 - 25 cm

Campbells Walsh Urology

10th Ed.2012

Urethral stricture

Jill C UROLOGY 83, 2014

Indications
First

case of uretral stricture

Short (<1cm)urethral stricture
Simple

Manual Endourology.2005

ContraIndication
Purulent

urethritis
Urethral abscess

Preoperative preparation
Check

the indication for urethrotomy.

Check the diagnostic tools
(uroflowmetry, urethrocystography)
Provide perioperative antibiotic
prophylaxis.

Cold light fountain

standard (endoscope
lamp)
Irigation slang with
luerlock
Sachse optical
urethrotome
Ureteroscope
Telescope : Optic 0
guidewire
Sterilized hand scoen,
Linen set, aquabides or
normal saline
Povidone iodine 10%,
sterile gauze

instrumentation

instrumentation

instrumentation

instrumentation

Camera and light

source

Monitor

Operative technique
The

patient is placed in the lithotomy

position.
After genital disinfection, sterile drapes
are placed in the usual fashion as for
any transurethral procedure.
The incision can be done blindly with an
Otis urethrotome or under direct vision
with a cold knife instrument.

Otis Urethrotomy
Introduce

the well-lubricated urethrotome

with the knife hidden inside the instrument
into the external meatus.
Pass the instrument through the stricture
and open it until it lies in close contact with
the lumen.
Make the cut by moving the roof-like knife
from the resting position and pulling it back
through the stenosis at the 12 oclock
position. Do not move the instrument itself.

one smooth cut has to be made

better healing of the urethral mucosa,
lower tendency for stricture recurrence
open the Otis urethrotome a few French
units until it once again lies in firm
contact with the urethral wall
make a further cut by re-advancing the
knife in the proximal direction
only

Direct Visual Internal

Urethrotomy
Fill the urethra with a lubricant jelly.
After calibrating the meatus, introduce the
urethrotome into the distal urethra.
Move the instrument under direct vision until the
stenosis is visible
In case of a very narrow stenosis, pass a ureteral
catheter (3 Fr) or guidewire through the stricture
into the bladder to guide the blade and prevent
protrusion of the urethrotome into tissues outside
the corpus spongiosum.

 Advance

the cold knife under vision into the

stricture guided by this catheter.
Depress the proximal end of the urethrotome and
cut upwards at the 12 oclock position through
the stricture.
Make the cuts by extending the blade and
moving the entire operating scope as a unit. The
incision advances millimeter by millimeter
towards the bladder as the scalpel blade is
extended out of the sheath and brought into
contact with the stricture itself.

The aim is to achieve a lumen of 2426

Fr in the region of the stricture.
Ensure there is sufficient vision before
continuing.
Be careful not to injure the striated
external sphincter when you are cutting
at the proximal bulbar urethra.
In case of a short stricture, one pass with
the blade may be enough.

 make

a single incision at the 12 oclock

position or at 10 and 2 oclock, or
additionally at the 6 oclock
These multiple cuts must also be fullthickness incisions and not just
superficial lacerations.

 Internal

urethrotomy under vision is also

used for incision of symptomatic
postoperative bladder neck stenosis.
Usually three deep incisions at 4, 8 and
12 oclock are made

Manual Endourology.2005

Complications
Bleeding

(20%).
Penile or scrotal edema (13%)
Urethral perforation and via falsa (10%).
Urethral fistula.
Rectal perforation (10%)
epididymo-orchitis (9%)
meatal stenosis (9%)
incontinence (9%)
fever (3.6%)
extravasation (3.4%)
bacteremia (2.7%)
urinary sepsis (2.1%)
scrotal abscess (1.4%)
Erectile dysfunction (2%-10%)
Re stricture

Manual Endourology.2005

Post operative care

Provide

sufficient analgesic therapy.

Monitor urine colour.
The catheter can be removed after 7
days.
Monitor uroflowmetry
Provide regular urological follow-up.