Vision Guided Internal Urethrotomy

™ Fill the urethra with a lubricant jelly. ™ After calibrating the meatus, introduce the urethrotome into the distal urethra. ™ Move the instrument under direct vision until the stenosis is visible (O Fig. 2.4). ™ In case of a very narrow stenosis, pass a ureteral catheter (3 Fr) through the stricture into the bladder to guide the blade and prevent protrusion of the urethrotome into tissues outside the corpus spongiosum. ™ Advance the cold knife under vision into the stricture guided by this catheter. ™ Depress the proximal end of the urethrotome and cut upwards at the 12 o'clock position through the stricture (O Fig. 2.5). ™ Make the cuts by extending the blade and moving the entire operating scope as a unit. The incision advances millimeter by millimeter towards the bladder as the scalpel blade is extended out of the sheath and brought into contact with the stricture itself.

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