Illustration of the steps of urethral dilation

Male urethral stenosis is a common disease in urology. It can be divided into three categories according to its causes: congenital, inflammatory and traumatic. Congenital urethral stenosis is rare, such as congenital narrow urethral orifice, urethral orifice heart valve, spermatic caruncle hypertrophy, urethral lumen narrowing, etc. Inflammatory urethral stenosis is caused by specific or non-specific urethral orifice infection. Among specific infections, gonorrheal urethral stenosis is more common; among non-specific infections, external urethral orifice and genital urethral stenosis caused by repeated prepuce hyperplasia and inflammation of the glans penis are common. Inflammatory urethral stenosis caused by improper indwelling catheters has attracted widespread attention. This type of stenosis is common in the urethral orifice of the cavernous body of the penis, and the scope is wide. Traumatic urethral stricture is the most common acquired urethral stenosis. The location of the stenosis depends on the location of the injury. Those caused by perineal straddle injuries are mostly at the bulbar urethral orifice. Those caused by pelvic fractures are located at the urethral orifice of the membranous part or the apex of the prostate. Generally, the narrowing is not long, but the scar is harder.

More serious urethral stenosis can cause water accumulation in the upper urethra and damage kidney function. Inflammation often occurs in the distal and surrounding tissues of the urethral stenosis. Some cases may be complicated by perinephritic inflammation and perinephritic cysts, and even rupture to the scrotal vulva, resulting in long-term and difficult-to-heal urethral fistulas. Urinary and reproductive system infections are also common. Some cases also include supraphalangeal cystostomy. Preoperative preparation should be done according to the detailed circumstances.

If the narrowness is relatively mild and the scar is not severe, it is expected that the urethral stricture can be cured through dilation surgery. If the urethral stricture dilation surgery is unsuccessful or ineffective, other surgical treatment methods should be selected. Endoscopic surgery for the treatment of urethral stricture is undoubtedly effective and has been widely used in clinical medicine. It has the advantages of less trauma, less bleeding, and fewer postoperative complications. It should be used as the preferred method for the treatment of urethral stricture. However, it requires unique equipment. For patients with multiple urethral strictures, especially those with narrow segments, open surgery is still the key method. Therefore, endoscopic treatment cannot completely replace other surgical treatments.

The process of urethral dilation surgery

1. Insert the probe into the urethra

If the patient is lying flat, the operator stands on the patient's left side (the right side is also acceptable, depending on the operator's habit); if the patient is in lithotomy position, the operator can stand between the patient's two thighs. The operator holds the probe handle with the thumb, index finger, and middle finger of the left hand, and the probe is coated with sterile testing lubricant. The right hand helps the patient's male genitals to straighten it up, separates and fixes the external urethral opening with the thumb and middle thumb, and slowly inserts the probe into the urethral oral cavity.

2. Insert the probe into the ball

After the probe is inserted into the external urethral opening, it is kept parallel to the patient's abdominal cavity and the probe is inserted inward again. After passing through the vaulted urethral opening, the tip of the probe slides into the bulbar urethral opening.

3. The tip of the probe passes through the membranous urethral opening

After the tip of the probe enters the bulbar urethral opening, the patient loosens his right hand to allow the male genitals to stretch without support. He then gently pushes the probe slowly toward the posterior urethra, while lifting the probe from a position parallel to the abdominal cavity to a vertical position, so that the tip passes through the membranous urethral opening and enters the male prostatic urethral opening.

4. The tip of the probe enters the bladder

After the tip of the probe passes the membranous urethral opening, push the probe forward and dilate it from a vertical position to a parallel position with the abdomen. When it is completely parallel, the front side of the probe has entered the bladder, and the actual operation of the urethral stricture dilation surgery is completed. When the probe enters the bladder, it can be twisted up and down in the urethral opening and bladder. After the urethral stricture dilation surgery is completed, remove the probe in the reverse procedure according to the above operation process.