From the Guidelines
Urethral stretching, also known as urethral dilation, can be performed as an in-office procedure for appropriate cases, as stated in the most recent guideline amendment from 2023 1. This procedure is typically done to treat urethral strictures or narrowing that causes difficulty with urination. The procedure involves gradually stretching the urethra using specialized dilators of increasing sizes. For simple, short strictures, in-office dilation is often feasible under local anesthesia using lidocaine gel (2%) applied to the urethra 5-10 minutes before the procedure. The procedure typically takes 15-30 minutes, and patients may experience mild discomfort, burning during urination, and possibly small amounts of blood in the urine for 24-48 hours afterward. Patients should increase fluid intake after the procedure and may be prescribed antibiotics such as ciprofloxacin 500mg twice daily for 3-5 days to prevent infection. For complex or lengthy strictures, or for patients who cannot tolerate the procedure while awake, urethral dilation may need to be performed in an operating room under general anesthesia. The success of in-office dilation depends on the location, length, and severity of the stricture, with recurrence being common, particularly for longer or more severe strictures, as noted in the 2023 guideline amendment 1. Some key considerations for patient selection and treatment approach are outlined in the American Urological Association guidelines from 2017 1, but the most recent amendment from 2023 1 provides the most up-to-date recommendations for urethral stricture treatment, including the use of urethroplasty and self-catheterization. In-office urethral dilation is a viable option for patients with short, simple strictures, but urethroplasty may be recommended for more complex cases, as stated in the 2023 guideline amendment 1. Key factors to consider in decision-making include stricture etiology, location, and severity, as well as patient preferences and goals, as emphasized in the 2017 guidelines 1. Overall, the approach to urethral stricture treatment should be individualized based on the specific characteristics of the stricture and the patient's needs, with a focus on minimizing morbidity, mortality, and improving quality of life, as noted in the 2023 guideline amendment 1.
From the Research
Urethral Stretching as an In-Office Procedure
- Urethral stretching, also known as urethral dilation, can be performed as an in-office procedure, depending on the specific technique and patient conditions 2, 3.
- Studies have shown that urethral dilation can be safely performed in an outpatient setting, with or without local anesthesia 4, 5, 6.
- The use of local anesthesia, such as intraurethral lidocaine, can make the procedure more comfortable for patients and reduce the need for general or regional anesthesia 4, 5, 6.
- However, the feasibility of urethral stretching as an in-office procedure may depend on the length and severity of the urethral stricture, as well as the patient's overall health and medical history 2, 3.
Techniques and Anesthesia
- Various techniques can be used for urethral stretching, including balloon dilation and optical internal urethrotomy (OIU) 2, 4, 6.
- Local anesthesia, such as lidocaine, can be used to reduce pain and discomfort during the procedure 4, 5, 6.
- Sedation and analgesia may also be used in combination with local anesthesia to improve patient comfort and reduce anxiety 5.
Patient Selection and Safety
- Patient selection is important to ensure the safety and effectiveness of urethral stretching as an in-office procedure 2, 3.
- Patients with shorter urethral strictures (<2 cm) may be more suitable for in-office procedures, while those with longer strictures may require more invasive treatments 3.
- The use of local anesthesia and sedation can help to reduce the risks associated with urethral stretching, but patients should still be carefully monitored and evaluated for any potential complications 4, 5, 6.