A day procedure under local anaesthetic, where a flexible cystoscope is placed in the bladder via the urethra. Narrowing in the urethra is dilated.

Why is it done?

A cystoscopy is used to investigate:

• Hematuria (blood in the urine)
• Recurrent urinary tract infections
• Dilatation of Urethral narrowing/ stricture
• Abnormal cells suggestive of urothelial carcinoma, on urine cytology

Ideally a retrograde urethragram is used to diagnose this radiologically

 

Risk factors for strictures:

• Straddle injuries
• Catheterization or urethral instrumentation
• Infections
• Bypass cardiac surgery with long ischemic time

 

How is it done?

• A cystoscopy is performed by placing a camera in the urethra with the help of a lubricant jelly and saline
• Usually, you can’t move past the narrowing
• Then:

Urethral Dilatation

• If you have a urethral stricture, a guidewire will be placed and the narrowing dilated
• There may be some hemorrhaging and you may need a catheter for 3 days
• This will be removed at the hospital in 3 days or alternatively arrange for your GP to remove.
• I will review in 6 –8 weeks

Antibiotics may be given to prevent infection

Complications

What to expect after the procedure?

• You may be sent home with an indwelling catheter for 3 days
• Pain on initial passing of urine after it is removed
• Bladder infection ranging from a burning sensation to, fever, to puss (rare)
• Bloodstained urine
• Lower abdominal discomfort which will persist for a few days
• NB! Each person is unique and for this reason, symptoms vary.

 

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Wes Flexible Cystoscopy and Urethral Dilatation IDC

Copyright 2019 Dr. Jo Schoeman

• To treat a narrowing in the tip of the urethra which has formed due to previous damage/injury to the urethra.
• Where intermittent dilatation is not desired, as discussed with the patient.
• Causes:
  • Circumcision in early childhood where the foreskin is still attached to the glans, usually neonatal circumcision
  • After bypass surgery where a drop in blood pressure has caused an area of low blood supply to the urethra.
  • trauma to the urethra (pelvic fractures/ urethral instrumentation).
  • and sexually transmitted diseases.
• The procedure involves surgical refashioning of your meatus.

How is it done?

• Usually done in male patients
• Selected Female patients can be considered.
• Patients will receive a general anesthetic.
• Your meatus will be refashioned, in order to leave it patent without a narrowing.
• An indwelling catheter is left till post-operative period.
• Prophylactic antibiotics may be given to prevent infection.

What to expect after the procedure?

• It may be slightly uncomfortable.
• A catheter will be inserted in the urethra and bladder. This will remain in until you are awake.
• Catheters can be very irritating and cause some discomfort.
• Blood stained urine will be present.
• Painful urination may persist for a few days.
• NB! Each person is unique and for this reason symptoms may vary!

What next?

• Patients will be sent home after a successful attempt at voiding.
• You may experience some discomfort with every void, that will become less over the next few voids.
• There may be some blood in the urine. This can be remedied by drinking plenty of fluids until it clears.
• On discharge a prescription may be issued for patients to collect.
• Patients should schedule a follow-up appointment with Dr Schoeman within 6-8 weeks.
• Should patients have any problems with urination, please contact the rooms for an earlier appointment.
• Please don’t hesitate to direct any further queries to Dr Schoeman’s rooms.
• PLEASE CONTACT THE HOSPITAL WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

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Wes Meatotomy

Why is it done?

• To treat a narrowing in the urethra which has formed due to previous damage/injury to the urethra.
• Causes:
  • After bypass surgery where a drop in blood pressure has caused an area of low blood supply to the urethra;
  • Trauma to the urethra (pelvic fractures/ urethral instrumentation);
  • Sexually transmitted diseases.
• The procedure entails cutting the stricture with a cold knife.

How is it done?

• A urethroscopy is performed by placing a camera in the urethra, with the help of a lubricant jelly and an irrigate fluid, to identify the stricture.
• A cold knife is then used to cut the stricture open.
• The inside of the bladder is viewed for pathology.
• If any suspicious lesions are seen, a biopsy will be taken.
• Prophylactic antibiotics may be given to prevent infection.
• Indwelling catheter placed.

 

Complications

Side–effects

• Patients will spend the night in the hospital.
• Patients will be sent home with a catheter for 3 days after receiving thorough catheter care Instructions.
• Arrangements will be made to remove the catheter on day 3.
• There may be some blood in the urine. This can be remedied by drinking plenty of fluids until it clears.
• Review at 6 weeks.
• There is a >50% risk of recurrence and may need further treatment
  • Re-dilatation
  • Self-dilatation
  • Urethraplasty

 

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Wes Optic Urethrotomy

Copyright 2019 Dr Jo Schoeman

Why is it done?

• As part of the treatment for aggressive localized Urothelial carcinoma of the bladder.
• T1G3, > T2 disease.
• Primary Urethral disease with:
  • Urothelial Carcinoma.
  • Squamous cell carcinoma.
  • Secondary metastatic disease to Urethra: Melanoma, Lung cancer, Breast cancer (all these are rare).

• Advanced disease may involve a penectomy.
• The procedure is part of the radical cystectomy, radical cysto-prostatectomy or could be and adjunct later on when recurrences are found with surveillance.
• Part of a necrotic inflammatory condition ie: Fourniers Gangrene.

How is it done?

• This procedure is done under general anesthetic.
• Legs are placed in a lithotomy position.
• A single incision is made on the midline raphe on the perineum (area between scrotum and anus). Sutures will be dissolvable.
• The Corpora Spongiosum with the urethra inside it is mobilized off the Corpora Cavernosa.
• Urethral meatus is removed distal and glans is closed.
• Proximally the urethra is taken up to the sphincter and freed.
• You will have already had a diversion of the urine with an ileostomy, or this will be done with your cystectomy part of the operation.
• A drain will be left for 24-48 hours to prevent the collection of serous fluids.
• A dressing is then applied, which should be removed after 72 hours.

What to expect after the procedure?

• Any anesthetic has its risks, and the anesthetist will explain all such risks.
• If this is the only operation you have undergone, you will be sent home as soon as the drain is removed on D2 or D3.
• Swelling is a common complication.
• A hematoma (blood collection under the skin) may form and needs to be reviewed by Dr Schoeman as soon as possible. Bruising is normal.
• An infection of the wound may occur and requires immediate attention.
• Owing to the area of the surgery the wound should be kept clean and dry.
• DANGER SIGNS: A wound that swells immediately, fever, or puss. Please contact Dr Schoeman or the hospital immediately as this may occur in up to 15 % of all cases.

What next?

• The dressing should be kept dry for the initial 72 hours after surgery and then soaked in a bath until it comes off easily.
• The dressing may sometimes adhere to the wound causing slight bleeding on removal. Don’t panic, the bleeding will stop.
• On discharge a prescription may be issued for patients to collect.
• There will be signs of bruising for at least 10 days.
• The suture-line will be hard and indurated for at least 8-10 weeks.
• PLEASE CONTACT THE HOSPITAL DIRECTLY WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

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Wes Urethrectomy