Urethroscopy is an examination of the urethra through a urethroscope. The urethra is the tube that transports urine outside the body. It passes through the penis in males carrying semen as well as urine, and in females it emerges above the vaginal opening. If a patient experiences pain, discomfort, infection, or injury anywhere in the bladder area, a urethroscopy is often recommended. A urethroscopy may be called for if there is a suspected growth or blockage in the urinary bladder or if a biopsy by removing a small piece of tissue for examination, of the bladder or urethra needs to be done.
Endoscopic inspection via a urethroscope with a 0-degree lens is helpful to identify and aid in treating urethral pathology. Stricture disease can be identified or confirmed after radiographic studies. Strictures are characterized by circumferential narrowing. Sequential dilation of urethral strictures by inserting catheters of increasing size exerts shear and tear forces to the mucosa and is likely to produce extended scarring. Thus, stricture recurrence is common if periodic urethral dilation is terminated. Balloon dilation of a stricture with 7-9F balloon dilators, which can be passed over guide wires and inflated up to 30F with pressures of up to 15 atm, does not exert shear force. However, the long-term results are poor. Limited circumferential strictures can be incised under direct vision with a cold knife. The incision is usually made at the 12 o’clock position, adequate to allow passage of the urethroscope. The bladder then can be evacuated and adequate irrigation used if further incision results in hemorrhage. It is difficult to identify the true limits of a stricture solely by vision.
An obturator with a beak that can be curved is being used together with the urethroscope, which is being slipped inside the urethra and into the bladder. Straighten the beak, withdraw the obturator and leave this sheath in place. The urine escapes. Insert the irrigating nozzle into the tube up to the rubber stopper and fill the bladder. If it is foul withdraw the irrigating nozzle to drain the bladder, then repeat filling and emptying the bladder until the outflow is clear. Lastly keep the bladder filled with clear solution, by holding the left thumb over the outlet of the sheath. The right hand lays aside the irrigating nozzle, takes up the periscope and carries it quickly and smoothly home in the sheath, the left thumb having been removed at the last moment. Should too much fluid have escaped in this manipulation leaving the bladder insufficiently distended, or should one prefer to have a stream of fluid flowing constantly and directly over the field of vision while cystoscoping, insert the tip only of the irrigating nozzle into the small rubber tube attached to the open side tap. Should the bladder get too full during manipulations turn off the inflow and loosen the periscope in its socket sufficiently to allow the super abundant fluid to escape.
A urethral diverticulum can be confirmed with urethroscopy. If it has been identified, a catheter can be placed through the neck of the diverticulum to help identify it during definitive open surgical repair. Urethroscopy can be used to inject dye into rare retained mullerian duct cysts, to identify and extract foreign bodies or rare calculi, and to access biopsy suspicious lesions. Urethroscopy allows endoscopic access to treat urethral condylomata.