Several months ago, you were diagnosed as having a urethral stricture, and told in these exact words: "they have a tendency to recur". Well,, it's "x" number of months later, and your stream has diminished to a mere fraction of what it was immediately after your first dilitation (which was probably done under sedation). It's time to head to the urologist, what should you expect?
Don't be afraid, while dilitation is not the most comfortable thing in the world to have done, it is also far from the worst. You'll go into the office, provide a urine sample (drink a few glasses of water 45-minutes before the appointed time), be lead back to a treatment room, and told to disrobe from the waist down. Your physician will appear, ask you how things have been with regards to the stricture, and if no other complications have arisen, he (or she) will tell you that "maybe it's time that we performed a dilitation. He (or she) will use a medicated 4x4 containing Povidone iodine (Betadine) to cleanse your urinary meatus (the opening of the urethra), and instill about one fluid ounce of a viscous topical anesthetic containing lidocaine or bupivicaine. You'll feel some pressure as your urethra fills with the anesthetic, and truthfully, for me, I disliked this more than the dilitation itself. A penile crown clamp will then be applied to the "penile corona" a.k.a. the base of the head of the penis (to keep the medication inside the urethra), and allowed to take effect for at least ten-to-fifteen minutes.
Depending on the location, length of, number of strictures (and their alignment), and the degree of difficulty which you are having establishing a stream, the selection will be made between dilitation using metallic urethral sounds, or a system of woven fibre catheters called "filiform and followers". Better streams usually receive dilitations with the metal sounds, while the more complex dilitations are carried out using the filiform and followers.
Metal sound dilitation:
The clamp will be removed, and sounds (most often Van Buren sounds are employed) of increasingly graduated sizes will first be lubricated with a water-based lubricant (Surgilube or K Y Jelly) and gently passed through the urethra and into the bladder, gradually widening the passage through which the urine flows. Once in the bladder, the penis and sound combination will be manipulated "North, East, South, and West" in order to ensure all sides of the stricture are addressed with equal attention. On average, four different diameters of sounds will have to be used in order to achieve the 24-Fr (Fr = French, a medical unit of measurement similar to the "gauge" terminology commonly used in life) optimum urethral diameter. Once the desired status of your urethra has been re-established, you will be allowed to relax for a few minutes, and asked to urinate.<---this is important! Urination cleanses the urethra, and helps remove any blood, anesthetic, or lubricant from the urethra, thus lessening the possibility of infection.
Filiform and followers dilitation:
The clamp will be removed, and a thread of woven fiber about the diameter of a bass guitar string will first be lubricated with a water-based lubricant (Surgilube or K Y Jelly) then "manipulated" into the opening of the stricture by gently moving the filiform through the narrowed stricture and into the bladder using an in-and-out motion, much in the same way that a needle is threaded. A good portion of the end of the filiform will be allowed to remain in the bladder in order to maintain positioning for the followers, which as the word says, "follow". After application of lubricant, a slightly larger follower is gently threaded onto the exposed end of the filiform, and gently passed through the stricture and into the bladder. This process is repeated four or five times with increasingly wide followers, again, gradually widening the passage through which the urine flows., until the desired 24-Fr urethral diameter is achieved. The maximum diameter sound may be allowed to remain in-place for up to twenty minutes in more complex "multi-stricture" cases. After removal, you will be allowed to relax for a few minutes, and asked to urinate.<---this is important! Urination cleanses the urethra, and helps remove any blood, anesthetic, or lubricant from the urethra, thus lessening the possibility of infection.
I was hesitant about the addition of this link to a Youtube video of a urethral dilitation with metal sounds, as this patient is obviously under general anesthesia, and the physician can be a little less gentle with the dilitation. You may notice that there is a very slight resistance when the first sound is inserted, this is the apparent location of the stricture (it is probably a penile urethral stricture, and not a bulbar urethral stricture, as are most. Note: due to the subject/situation of the video, there is unavoidable nudity contained within. Viewer discretion is advised.
Per: Moderators César and Tim
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