It consists in introducing a progressively higher gauge probes or catheters into a stenotic urethra. It can be curative (the only procedure that resolves stenosis, although extremely unusual!) or for maintenance (in that case it is intermittent and is conducted at regular intervals to maintain the result obtained without having to resort to other more “invasive” procedures).
Once this was the only therapy for urethral stenosis: currently the approach is to give a definitive solution to the problem by traumatizing as little as possible the urethra that has shown little compliance with the passage of a catheter 14 Ch and, by positioning a temporary epicystostomy, by programming the resolutive treatment.
For patients who are not in the condition of benefiting from other treatments or do not want them at all, a angled-tip catheter (and rounded-tip catheter to prevent penetration into the urethra by creating a false path) is used, starting from the smaller ones and arriving to the one that meets resistance to the passage; Stopping at this, you may be able to make the patient come back after two weeks by introducing one or two bigger gauge catheter; However, you will not have to go beyond with a catheter of a gauge greater than 24 Ch. When these catheters passes through regularly you can gradually extend the interval between the single sessions, considering a good result having a session every 6 or 12 months.
In tight stenoses, it may also be possible to introduce a guide wire through the urethral lumen and to slide progressive dilators (similar to those used in creating percutaneous access to the kidney) using Seldinger’s technique. Another possibility is that associated with the use of a catheter with a balloon at least as long as the front urethra, which is inflated inside the lumen, favoring an expansion of the entire urethra with a mechanism that exploits, on the stenotic tract, the centrifugal force and avoids mucous lacerations produced by progressive routine dilatations.
Preparation for intervention:
It is essential to proceed with appropriate antibiotic prophylaxis.
Duration of intervention:
Type of anesthesia:
Type and duration of hospitalization:
Routinely in outpatient.
Exceptionally long lasting; They can usually be maintained by repeating the procedure.
Relatively low-intrusive maneuver.
It almost never solves the problem definitively.
The same as the urethral catheterisation (urethralgia and the creation of “false paths” for the possible damage of the urethral wall: the immediate recognition of this allows to proceed without any further damage; it may be conservative, possibly executing an external compression on the urethra to prevent bleeding and / or, if necessary, deriving the urine from the bladder by a “minimal” cystostomy).
Attempts to resign:
Hydroponic therapy and quality check of urination.