After your surgeon's fifth cup of coffee and a pit-stop in the bathroom, the OR staff will transfer you over to a gurney for transport to the OR. You will again be asked which procedure you are having performed (this is one time when being a smartass doesn't pay), asked to transfer onto the operating table, and placed into the lithotomy (OB/GYN) position, stirrups and all. Your choice of anesthesia will be started and this is what happens next:
- Your urinary meatus will be exposed and cleansed with a Povidone-iodine wipe (Betadine), and approximately 30 cc's (one fluid ounce) of a viscous topical anesthetic containing lidocaine (usually Anestacon) will be instilled into your urethra, then held in the urethra by applying a crown clamp to the base of the head of the penis (the penile corona). Depending upon your choice of anesthesia, your physician may choose to begin immediately (using the viscous anesthetic as a lubricant for the cystoscope), or wait a few minutes for it to take effect.
- A cystoscope with a trans-urethral injection system will be inserted into the urethra, and the surgeon will inject lidocaine (a local anesthetic) into the length of the stricture at various points using a technique called "infiltration".
- The cystoscope/injection system will be withdrawn, and a cutting device called a urethrotome will be attached to the cystoscope and inserted. A safety guide filament will be threaded through the stricture, and into the bladder. This helps the surgeon position the urethrotome in a safe aspect for performing the incisions into the stricture Next, the surgeon will guide the urethrotome to the face of the stricture and a small blade towards the tip of the instrument will be deployed using a trigger mechanism to cut the stricture at locations he or she believes will provide optimum relief. The urethrotome/safety guide/cystoscope will then be withdrawn, and an appropriately sized catheter will be inserted and connected to a urinary drainage system (catheter hose and bag).
- You will be instructed on the care and emptying of the catheter/drainage system/bag, and given prescriptions for an antibiotic/systemic antibacterial, a urinary analgesic (pyridium or prosed), a few days of a minor pain medication (there is usually very little pain associated with urethrotomy), and instructed to see the surgeon in three to seven days for removal of the catheter.