Meatal or urethral dilatation

Q 1. What is this procedure?

A. Stretching (Dilatation) of the urethra or the urethral opening for narrowing resulting in a poor urinary stream.

Q 2. What are the alternatives to this procedure?

A. The alternatives include:

• Surgical enlargement of the urethral opening (Meatotomy or meatoplasty)
• Optical urethrotomy
• Self-dilatation
• Observation.

Q 3. What should I expect before the procedure?

A. If you are taking blood thinning medication on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits. Aspirin does not usually need to be stopped but will be the decision of your surgeon.

You will usually be admitted on the same day as your surgery, or a day before. You will normally undergo pre assessment on the day of your clinic. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and nurse.

You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.

Please be sure to inform your urologist in advance of your surgery if you have any of the following:

• Co-morbidities like Diabetes, Hypertension, Coronary artery disease or, stroke, epilepsy
• Any transmissible disease like HIV/AIDS, Hepatitis B or C etc
• Presence of implants, pacemakers, graft etc

You are taking prescription drugs like-

• Blood thinners/ anti-platelets i.e. Warfarin, ecosprin, clopidogrel etc
• Anti-epileptics like phenytoin, valproate etc

Q 4. What happens during the procedure?

A. Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you.

You will usually be given injectable antibiotics before the procedure, after checking for any allergies.
The urethra or urethral opening is stretched using metal or plastic dilators after passing local anaesthetic jelly to numb and lubricate the passage. Inspection of the bladder and urethra is likely to take place at the same time, especially if plastic dilators are used.

Q 5. What happens immediately after the procedure?

A. The urethra or the opening of the urethra is stretched using a variety of instruments. It may be necessary to insert a catheter in the urethra (water pipe) after the procedure. Average hospital stay is one day.

Q 6. Are there any side effects?

A. Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.

Common (greater than one in 10)

• Mild burning or bleeding on passing urine for a short period after the operation
• Infection of the bladder requiring antibiotics
• Temporary insertion of a catheter
• Further stricture formation requiring repeated dilatation

Occasional (between 1 in 10 and 1 in 50)

• Damage to the urethra resulting in a “false passage” and the need for further surgery
• Infection around the urethra resulting in abscess formation

Rare (less than 1 in 50)

• Delayed bleeding requiring removal of clots or further surgery