Optical Urethrotomy / Bladder Neck Incision

Stricture is scar tissue that forms within the urethra, narrowing the tube diameter and obstructing the flow of urine from the bladder. In most instances, the cause is unknown. However, it may be secondary to injury or infection.

Depending on the length and position of the stricture, it may be treated telescopically (optical urethrotomy). This avoids some of the risks of open surgery and allows for a shorter hospital stay and rapid recovery of normal function. It is performed under general anaesthetic, the stricture being incised to allow the telescope to pass into the bladder. A catheter may be left a few days to splint the urethra open.

Although initially successful, stricture will recur in at least 50% of patients and further treatment will be required.

Bladder neck obstruction (BNO), like stricture, may be scar tissue following previous prostate surgery, or may be a primary problem of muscular spasm during voiding. Again, urine flow is reduced and bladder drainage obstructed. The majority of BNO may be treated telescopically, but unlike stricture, BNO does not tend to recur. Notably, < 20% of patients develop reduced (retrograde) ejaculation which may interfere with fertility.

Pre-operatively:

• urine sample to the laboratory 1 week prior to surgery
• discontinue aspirin 1 week prior, other medications may need to be stopped
• nil by mouth from midnight

Post-operatively – early:

• day 1: diet, reinstate usual medications, up and about, maintain a high fluid intake (2 litres daily) for 2 weeks
• day 1 - 2: remove urethral catheter and assess voiding, then home
• avoid heavy lifting for 4 weeks; thereafter resume full normal activity including sexual intercourse

Although most cases proceed without particular difficulty and have excellent outcomes, surgical complications occur overall in 5% of patients. The list below details complications recognised as common or serious, but this does not include the rare and extraordinary.

• Following removal of the catheter, most patients experience some burning with voiding, frequency and urgency
• Potency is not affected overall by either procedure
• Bleeding requiring transfusion in < 5%
• Infection
• Numbness or tingling, usually temporary
• Persisting lower urinary symptoms
• Death < 0.5%

This fact sheet complements the discussion during your consultation, which will apply your individual circumstances to the above facts.