Urethral stricture was a very common condition which can leads to a serious complications like urinary infections & renal insufficiency secondary to urinary retention. Treatment choices may include like: catheterization, dilation, urethroplasty and endoscopic internal urethrotomy. Optical internal urethrotomy may offer faster recovery with minimal scarring & less risk of the infection, even though recurrence was possible.
PROCEDURE:
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A suprapubic catheter is in the place via suprapubic cystostomy, the urinary bladder will be filled with 300 milliliters of the diluted iodinated contrast (contrast/normal saline: 1/3). A 0035′′ J-tip standard angiographic guide-wire is introduced or inserted into the urinary bladder by the suprapubic catheter.
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The latter is removed & exchanged with a short (11 cm), 5-French angiographic sheath. The angiographic guidewire is consequently taken away & an angiographic catheter was loaded with a hydrophilic, J-tip guidewire is inserted into the bladder.
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Under fluoroscopy the catheter-guidewire combination were guided towards the proximal urethral orifice & consequently into the urethra. The hydrophilic guidewire is used & finally advanced by the penile urethral orifice.
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The angiographic catheter is then advanced by the stenosis, above the guidewire. The hub of the catheter was cut off & the vascular sheath as well as the guidewire both are removed. The posterior part of the catheter was been stabilized on the abdominal wall with the suture.
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The patient was then taken to the operation theater & he will be placed in the lithotomy position after performing the spinal anaesthesia.
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The guidewire was also now placed antegrade by the angiographic catheter to assist the passage of angiographic catheter by the working channel of the rigid urethrotome. By keeping angiographic catheter in stretched state, the instrument is inserted & guided to the face of the stricture.
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The stricture was then incised or cut at the 12 o’clock location along with the entire stenosis. Upon completion of the internal incision(s), the instrument was taken away & an exact and correct size Foley catheter is inserted by the repair into the urinary bladder. Hospitalization will be for 2 days & the patient needs to keep the catheter for few days.
