Optical Internal Urethrotomy (OIU)

Optical internal urethrotomy is a surgical procedure used primarily to treat urethral strictures, which are narrowings of the urethra caused by scar tissue. The procedure involves using an endoscopic device to cut the stricture and widen the urethra, thereby improving urine flow. Here’s a detailed explanation of the procedure, its indications, and postoperative care.

Procedure Overview

• Instrumentation: Optical internal urethrotomy is performed using a cystoscope, which is a thin tube with a camera and light source that allows the surgeon to see inside the urethra. The device also has an attachment for a small knife or laser, which is used to make the incision.

• Technique: The patient is typically placed under general or spinal anesthesia. The surgeon inserts the cystoscope into the urethra up to the site of the stricture. Using the knife or laser, the surgeon makes a longitudinal incision through the stricture to relieve the narrowing. The incision is usually made at the 12 o'clock position to minimize the risk of further scar formation.

• Duration and Setting: The procedure is generally quick, often completed in less than 30 minutes, and is performed as an outpatient surgery, meaning the patient can go home the same day.

Indications

Optical internal urethrotomy is recommended for:

• Symptomatic Urethral Strictures: Particularly those that cause significant obstruction, leading to symptoms like decreased urine stream, straining to urinate, and recurrent urinary tract infections.

• Short Segment Strictures: Best results are often achieved in strictures that are less than 2 cm in length.

Risks and Complications

While generally safe, optical internal urethrotomy can have complications such as:

• Bleeding: Some blood in the urine is common after the procedure.

• Infection: There is a risk of urinary tract infections.

• Recurrence of Stricture: This is the most common complication, with many patients experiencing a recurrence of the stricture and requiring repeat procedures.

• Urethral Diverticula or Fistula: Though rare, these are potential complications due to the incision.

Postoperative Care

• Catheterization: Patients usually have a urinary catheter for a short period after the procedure to prevent the urethra from closing at the incision site.

• Medication: Antibiotics may be prescribed to prevent infection, and pain relief medication may be recommended.

• Observation: Patients are advised to monitor for signs of infection or excessive bleeding and to report any prolonged symptoms to their urologist.

• Follow-Up: Regular follow-up appointments are necessary to monitor the site of the urethrotomy and manage any recurrent strictures.

Long-Term Outcomes

The success of optical internal urethrotomy can vary. Some patients may achieve good long-term outcomes, while others may require additional treatments or alternative surgical interventions, such as urethroplasty, especially in cases of recurrent or complex strictures.

Optical internal urethrotomy offers a minimally invasive option for the treatment of urethral strictures, providing significant relief from symptoms for many patients. However, the potential for recurrence necessitates careful consideration and discussion with a urologist about the best treatment plan tailored to individual circumstances.