Urethral Dilation

Overview

Urethral dilation is a minimally invasive procedure used to treat urethral strictures, which are narrow bands of scar tissue that obstruct the flow of urine. The urethra is the tube that carries urine out of the body, and strictures can develop due to trauma, inflammation, infection, or unknown causes.

During a urethral dilation, a urologist enlarges the urethra using either a series of progressively larger rods (sounds) or a balloon that is gradually inflated. If the stricture recurs after an initial dilation, it is likely to reappear with further dilation attempts. In such cases, a more extensive surgical approach, such as urethroplasty, is usually recommended. If urethroplasty is not an option or is declined, repeated dilations may be necessary. Ongoing treatments, either at home or with a urologist, might be needed as the scar tissue can persist.

A urethrotomy is a specific type of urethral dilation. In this procedure, a urologist uses a pencil-sized tube with a camera (cystoscope) to examine the urethra. The cystoscope is equipped with a small knife (scalpel) that allows the surgeon to cut away scar tissue and widen the urethra.

Risks

There is a poor long-term success rate with urethral dilatation. It’s possible for you to experience another urethral stricture, in which case you could need to undergo an alternative surgery or repeat the initial one to clear your urethra.

Before the procedure

Before undergoing urethral dilation, you will meet with your doctor to assess your overall health. They will check your vital signs, including temperature, pulse, and blood pressure. They may also order imaging tests or perform a cystoscopy to evaluate the extent of your urethral stricture and possibly a urinalysis. If the urinalysis shows the presence of bacteria, you might need to treat an infection before proceeding with the dilation.

Be sure to inform your doctor about all prescription and Over-The-Counter (OTC) medications you are taking, including any herbal supplements. Some medications, such as aspirin, anti-inflammatory drugs, and certain herbal supplements, can increase the risk of bleeding. Your doctor will also give you instructions on when to stop eating and drinking before the procedure. If you will be sedated during the procedure, avoid eating or drinking for at least six hours beforehand. If you need to take prescription medications, do so with a small sip of water.

During the procedure

A specialized team of healthcare professionals will carry out the urethral dilation procedure. This team generally includes a urologist and nurses, and may also involve an anesthesiologist. Typically, the procedure is performed by the urologist while you are under anesthesia. If the procedure is done while you are awake, the urologist will use a numbing lubricant to minimize pain or discomfort.

After addressing the blockage, the urologist may use a cystoscope to examine your bladder for any additional issues in your urinary tract. Following the dilation of the stricture, a urinary catheter will be inserted to drain urine from your bladder as your urethra heals.

Urethral dilation usually takes less than an hour to complete.

After the procedure

After the procedure, healthcare providers will check the urinary catheter to ensure it is functioning properly and will provide guidance on how to care for it. Most patients can have the catheter removed after a few days and should find urination easier. During the catheter use, you might experience bladder spasms, which can create a sensation of needing to urinate even though the catheter is draining your bladder. It’s also possible to notice some blood in your urine (hematuria), but this is usually not a concern as long as most urine is draining through the catheter.

In some cases, your urologist may give you dilation tools and instructions for performing urethral dilation at home once the catheter is removed. Pain from the procedure should typically improve within a few days.

Outcome

Most people start to feel better within a few days after urethral dilation, but recovery times can vary. For a more precise estimate of your recovery period, consult your doctor.

To manage pain, you might use over-the-counter NSAIDs such as aspirin, ibuprofen, or naproxen. If NSAIDs aren’t suitable for you, ask your doctor about alternative pain relief options.

Your doctor will let you know when to schedule follow-up appointments. During these visits, they will remove your urinary catheter and check if you are emptying your bladder effectively. They may also assess the speed and strength of your urine flow.

Most people can return to work or school and resume light physical activities after a few days. If your job involves heavy physical activity, you may need more time off. Avoid intense physical activities until your doctor gives you the go-ahead.

Your doctor will also advise you on when it is safe to resume sexual activity, typically recommending waiting at least a week after the procedure.

Urethral dilation is successful in up to 60% of cases for strictures less than 2 centimeters long. However, the success rate may decrease over time, and further dilation or alternative treatments might be needed to address your symptoms.