Is urethral dilatation painful?

From the Guidelines

Urethral dilatation can cause discomfort or pain, but the level varies from person to person, and most patients experience some discomfort during the procedure, ranging from mild pressure to moderate pain. The procedure involves stretching the urethra, which contains sensitive nerve endings, triggering pain signals 1. According to the most recent guidelines, local anesthesia, such as lidocaine gel, is typically applied to the urethra before the procedure to minimize pain, and some patients may receive sedation for more comfort, especially if they have high anxiety or previous painful experiences.

Key Considerations

• The pain level during urethral dilatation can vary significantly between individuals, with some experiencing mild discomfort and others moderate pain 1.
• Patients with urethral strictures or inflammation may experience more discomfort than others during the procedure.
• After the procedure, patients commonly experience burning during urination, mild bleeding, and urinary frequency for 24-48 hours, which can be managed with over-the-counter pain medications like acetaminophen or ibuprofen (400-600mg every 6-8 hours) 1.
• Drinking plenty of water after the procedure helps reduce burning during urination and speeds healing.

Procedure and Management

The urethral dilatation procedure may involve the use of urethral endoscopic management, such as urethral dilation or direct visual internal urethrotomy, and the determination of urethral stricture length and location allows for shared decision-making about treatment options, perioperative expectations, and expected outcomes following urethral stricture therapy 1. Surgeons may also utilize suprapubic cystostomy for urgent management of urethral stricture, such as discovery of symptomatic urinary retention or need for catheterization prior to another surgical procedure.

Post-Procedure Care

If pain becomes severe or persists beyond a few days, patients should contact their healthcare provider as this could indicate complications. The guidelines emphasize the importance of patient-reported measures, uroflowmetry, and ultrasound post-void residual assessment in the initial evaluation of suspected urethral stricture, and the use of a combination of these methods can help detect low flow and poor bladder emptying, respectively 1.

From the FDA Drug Label

For surface anesthesia of the male adult urethra ... The jelly is instilled by an easy syringe-like action, until the patient has a feeling of tension or until about 15 mL (i.e., 300 mg of lidocaine hydrochloride) is instilled. About 30 mL (i.e., 600 mg) may be required to fill and dilate the male urethra.

The use of lidocaine jelly for urethral dilatation is intended to provide anesthesia, which implies that the procedure may cause discomfort or pain. The fact that a penile clamp is applied and the patient is asked to strain suggests that the procedure may be uncomfortable. However, the lidocaine is used to minimize this discomfort.

• The dosage of lidocaine hydrochloride jelly used for urethral dilatation is up to 600 mg.
• The goal of using lidocaine jelly is to provide effective anesthesia and minimize pain or discomfort during the procedure 2.

From the Research

Urethral Dilatation and Pain

• Urethral dilatation is a procedure that may cause discomfort or pain, but the level of pain can vary depending on the individual and the specific procedure being performed 3.
• A study on male urethral catheterization found that the use of topical lidocaine gel reduced the pain associated with the procedure compared to topical lubricants only 3.
• However, the studies on urethral dilatation for urethral stricture disease do not specifically address the issue of pain during the procedure 4, 5, 6.
• A study on women with overactive bladder symptoms found that urethral dilatation was associated with a significant short-term benefit in cure of urgency, but there was no significant benefit in symptom relief in the long term 7.

Minimally Invasive Treatment of Urethral Stricture

• Urethral dilatation and direct visual internal urethrotomy (DVIU) are widely used minimally invasive options to manage men with urethral strictures 4.
• A systematic review and meta-analysis found that adjuncts to minimally invasive treatment of urethral stricture disease, such as mitomycin C injection, can lower the recurrence rate and are associated with a low adjunct-specific complication rate 5.
• However, the studies included in the review were at high risk of bias, and the evidence for the use of adjuncts is not yet conclusive 5.

Intermittent Self-Dilatation

• Intermittent self-dilatation (ISD) may be recommended to reduce the risk of recurrent urethral stricture, and a systematic review and meta-analysis found that ISD may decrease the risk of recurrent urethral stricture 6.
• However, the quality of the evidence is very low, and a well-designed randomized controlled trial is required to determine whether the benefit of ISD is sufficient to make this intervention worthwhile 6.