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Examination, widening, eventual transection (woman)
What does this procedure entail?
The purpose of this medical procedure is
- accurate measurement of urethral lumen – or its outer orifice
- in the case of a slight narrowing, widening (divulsion) and, in the case of a significant narrowing, transection
- using a special knife (OTIS urethrotome)
- examination and assessment of mucosal condition and the interior of the bladder, urethral orifice, etc.,
the inner orifice of the urethra, as well as the urethra itself.
The most common reason for this examination is to search for the source of blood in the urine (possibility of a bladder tumour), the cause of unclear urinary disorders or problems with urinary incontinence, recurrent inflammation, etc. During this procedure, it is possible to perform sampling from the bladder and urethra wall, to treat bleeding areas using electrocoagulation (ELCO – high frequency current burns).
The procedure is performed under general anaesthesia and can be performed in an outpatient manner (divulsion) or during short-term hospitalisation (OTIS urethrotomy).
What are the alternatives to this procedure?
- Observation (follow-up)
- Urethral calibration without anaesthesia – for guidance only
- Eventual flexible cystoscopy (this procedure is reimbursed by some health insurance companies for women only in special cases, e.g., with significantly limited hip joint mobility).
- Dilatation (gradual dilation of the urethra) using dilatation tubes/catheters
What should I expect before this procedure?
If you regularly use Anopyrin, Clopidogrel, Warfarin, etc., you must tell your doctor. These medications can be associated with increased risk of bleeding during and after the surgery if they are not stopped in time. In some cases, it is necessary to replace these drugs with injection preparations. It is necessary to consult your general practitioner or cardiologist about this approach.
At the request of the referring physician, you will have to schedule preoperative examinations (if general anaesthesia is planed) to assess your overall condition, including laboratory and instrumental tests. If the report does not preclude the indicated procedure, you will be able to undergo the procedure / be admitted to the hospital. If you don’t undergo a preoperative examination or it is incomplete, you will not be able to have the surgery as scheduled. In case of hospitalisation, you will be admitted by a nurse and a member of the medical team will complete your examination and assess your fitness for the surgery. You will be asked not to eat or drink for at least 6 hours before the surgery!
Remember to inform your physician about the following possible facts before the surgery:
- artificial heart valve
- coronary artery stent
- artificial joint
- artificial vascular graft
- neurosurgical bypass
- other implanted foreign body
- use of the following prescription drugs: Acylpyrin, Anopyrin, Aspirin, Godasal, Clopidogrel, Plavix, Kardegic, Aspegic, Micristin, Ibustrin,Ticlid, Tagren, Ipaton Apo-Tic, Plavix, Persantin, Curantyl, Anturan, Aggrenox, Vessel due F.
- drug and other allergies
- any abnormalities or eventualities
It is NECESSARY to inform the physician about your use of drugs affecting blood clotting before your admission for the procedure.
What will happen during the surgery?
If an OTIS-urethrotomy is planned, you will usually receive antibiotics (injection or tablets) before the procedure, but any allergies must first be checked. Antibiotics are not always necessary for calibration and cystoscopy.
Special calibration probes (“bougies à boule") are used to accurately measure the urethral lumen and its outer orifice. In the case of a slight narrowing, this area is widened. If the narrowing is tighter, this area is cut with a special knife (OTIS uretrotome) in one or possibly more incisions. This procedure itself is sometimes performed only based on an indication and agreement as a second attempt during hospitalisation. A catheter is left inserted into the bladder for 2 days.
A telescopic instrument is used for cystoscopy, which is inserted through the urethra.
The overall procedure usually takes 10-15 minutes.
What will happen immediately after the procedure?
You will wake up after the procedure at the post-operative unit equipped for constant monitoring of patients immediately after the procedure. The surgeon will inform you about the course of the procedure. You will still have high levels of anaesthetics in your blood at that time, so you may not remember this conversation.
Once you are fully conscious, you should:
- ask if the planned outcome was achieved
- inform the medical staff about any problems
- ask what you can and cannot do
- ask all the questions you have for the healthcare professionals and members of the medical team.
- remember (and understand) why the surgery was performed, how it turned out, and what will follow
After you fully wake up after anaesthesia, you will be examined by an anaesthesiologist; if you agree, you may be discharged for further outpatient management. You will be leaving accompanied by an adult person, who will ensure that you do not drive or operate machinery. During hospitalisation, you will be transferred to a standard ward and, after your urinary catheter is removed, you will be discharged to home care (usually day 2 and 3 after the procedure).
What are the postoperative risks or complications?
Common (10% of procedures of this type)
- Mild burning or bleeding when urinating, mild bleeding from the urethra,also not during urination, for a short time after the surgery
- Temporary need for a catheter inserted into your bladder
Occasional (2-10% of procedures of this type)
- Inflammation of the bladder requiring antibiotic treatment
- The need for further solutions in case of a finding that requires it
- Scar/narrowing relapse requiring later management
Rare (may occur in 2% of procedures of this type)
- Subsequent bleeding requiring clot removal or surgical revision
- Injury to the urethra, which causes later scarring and narrowing or, conversely, a problem with urine retention
- Very rare bladder injury requiring temporary insertion of a urinary catheter or surgical revision.
- MRSA colonisation (0.9% – 1 of 110)
- Intestinal infection by clostridium difficile (0.01% – 1 of 10,000)
- MRSA blood infection (0.02% – 1 of 5,000)
Hospital infection rates may be higher in high-risk patients, such as in cases requiring long-term drainage, after a previous infection, after prolonged hospitalisation or after multiple hospitalisations.
What should I expect when I return home?
When you are discharged from the hospital, you should:
- Get recommendations on recovery at home
- Ask when you can return to normal activities such as work, exercise, driving, housework
- Get a contact number for further questions after returning home or in case of trouble
- Ask about the date and place of subsequent check-ups (hospital or your doctor)
- Make sure you are aware of the reason, course and outcome of the surgery, the results of examinations or the removal of tissues or organs
At your departure from hospital (sometimes several days later), you will receive a hospitalisation report / report on the performed procedure. The document contains important information about your hospital stay, your surgery and recommended follow-up. If you need to call your attending physician or visit the hospital for any reason, take this document with you so that the physician knows the details of your treatment. This is especially important if you need to consult another doctor or longer after discharge.
After returning home, you should drink 2x more fluids than normal for the next 24-48 hours. When urinating, you may initially experience burning and tingling up to pain, and blood may be present in the urine. A little blood may also be present on your underwear. These problems will quickly disappear if you have a high fluid intake. Increased hygiene is recommended – especially after urination.
What else should I watch out for?
If you develop a fever, severe pain when urinating, if you are unable to urinate or your bleeding gets worse, contact your doctor.
The calibration is usually repeated after divulsion. If necessary, divulsion is also repeated in about 6 weeks, so that the overall effect is as good as possible.