Urethral injury is a common condition that can prompt genuine complications like urinary infections and renal deficiency secondary to urinary retention. Treatment options include catheterization, urethroplasties, endoscopic internal urethrotomies, and dilation. Optical internal urethrotomy offers quicker recuperation, insignificant scarring, and less risk of infection, in spite of the fact that repeat is conceivable. However, specialized troubles related with poor visualization of the stenosis or of the urethral lumen might increment procedural time and substantially increment the disappointment paces of internal urethrotomy. In this report we portray a strategy for urethral catheterization by means of a suprapubic, percutaneous methodology through the urinary bladder to work with endoscopic internal urethrotomy.
Urethral injury causes an impeded or decreased progression of pee which can bring about a range of manifestations, from an asymptomatic presentation to serious discomfort. Moreover, it can prompt genuine complications like urinary infections and renal inadequacy secondary to urinary retention. Gruff perineal injury, urological instrumentation, chronic inflammatory disorders, for example, lichen sclerosus et atrophicus, and physically transmitted diseases are the most successive reasons for injuries; a huge proportion are iatrogenic. Treatment of urethral injuries is often troublesome on the grounds that this situation is described by high repeat rates and an important number of interventions are related with poor results. As of now, three unique interventions are utilized to treat urethral injuries: dilations, optical internal urethrotomy, and open urethroplasty . Treatment option relies upon the kind, length, and etiology of injury. However, the decision of treatment can be affected to changing degrees by the effortlessness of the technique, the inclinations of the patient, and the available accessories.
Case Report/Description of Technique
A 35-year-old male patient gave to our urology division an extreme (>5 cm), tortuous injury of the penile urethra, recently diagnosed by dropping cystourethrogram (Figure 1). A suprapubic catheter was set up. Through suprapubic cystostomy, the urinary bladder was loaded up with 300 milliliters of weakened iodinated (contrast/normal saline: 1/3). A 0035′′ J-tip standard angiographic guide-wire was embedded into the urinary bladder through the suprapubic catheter. The last option was eliminated and exchanged with a short (11 cm), 5-French angiographic sheath.
The angiographic guidewire was in this manner withdrawn and an angiographic catheter stacked with a hydrophilic, J-tip guidewire was embedded into the bladder. Under fluoroscopy the catheter-guidewire combination was directed towards the proximal urethral orifice and in this manner into the urethra. The hydrophilic guidewire was utilized and at long last advanced through the penile urethral orifice. The angiographic catheter was accordingly advanced through the stenosis, over the guidewire. The center of the catheter was cut off and the vascular sheath as well as the guidewire was eliminated. The posterior piece of the catheter was settled on the stomach divider with a stitch. The patient was then taken to the working room and he was set in lithotomy position under spinal anesthesia.
The guidewire was now positioned antegrade through the angiographic catheter to work with the section of the angiographic catheter through the working channel of the unbending urethrotome. By keeping the angiographic catheter extended, the instrument was embedded and directed to the substance of the injury. The injury was cut at the 12 o’clock location along the whole stenosis. Upon completion of the internal incision(s), the instrument was withdrawn and a fittingly estimated Foley catheter was embedded through the maintenance into the urinary bladder. Hospitalization endured 2 days and the patient kept the catheter a couple of days.
Internal urethrotomy enjoys the benefits of straightforwardness, effortlessness, speed, and short convalescence. However, achievement rates shift and long term outcomes are for the most part low. In the short term (under 6 months), achievement rates are 70 to 80 percent. Following one year, however, repeat rates approach 50 to 60 percent and by five years, repeat falls in the range of 74 to 86 percent . Albeit various examinations have proposed various etiologies as poor responders to optical internal urethrotomy, specialized and anatomical factors, for example, diminished visibility during the operation and injury length are uniformly perceived as predictors of repeat.
Other factors related with treatment disappointment are the perioperative urinary infection, the presence of periurethral fibrosis (spongiofibrosis), and injury etiology. No visible orifice on the substance of the injury and very limited, tortuous urethras predispose to urethral injury, bogus entry, and advancement of fistula. Injury builds the repeat rate significantly (from 28% if unharmed to 72% whenever harmed) and concomitantly the requirement for more techniques. The injury length has been likewise shown to be straightforwardly proportional to treatment disappointment. Check out for urethrotomy cost in india
Pandoro and Emiliozzi demonstrated high repeat rate for injuries more noteworthy than 1 cm. In their study, the achievement rate was 71% for injuries shorter than 1 cm contrasted with 18% for longer injuries . Retrograde instillation of methylene blue through the suprapubic catheter and/or antegrade advancement forwarding of ureteral stent are typically utilized to visualize the orifice of the organized urethra or to direct the urethrotome through a tortuous urethra, separately. The two stunts offer restricted help. In contrast, the retrograde position of the angiographic catheter securely directed the inflexible urethrotome through the limited urethra to the bladder neck.
Specialized and anatomical factors, for example, decreased visibility during the operation and injury length render optical internal urethrotomy troublesome. The retrograde situation of the angiographic catheter can securely direct the unbending urethrotome through the limited urethra to the bladder neck working within this way technique.