Urethrotomy in Korea

Urethrotomy in Korea


Urethrotomy, specifically direct vision internal urethrotomy (DVIU), is a minimally invasive surgical procedure used to treat urethral strictures, which are narrowings in the urethra. In Korea, urethrotomy is a common initial treatment for short, less complex strictures, aiming to cut the scar tissue and widen the urinary channel to improve urine flow.


Understanding Urethral Strictures & Indications in Korea

A urethral stricture is a scar in the urethra that obstructs the flow of urine.

  • Causes: Often result from trauma (e.g., catheterization, straddle injuries), infections (e.g., sexually transmitted infections), or inflammation. Some are idiopathic (cause unknown).
  • Symptoms: Include a weak or spraying urine stream, difficulty urinating, painful urination, frequent urges, incomplete bladder emptying, and recurrent urinary tract infections (UTIs).
  • Indications for Urethrotomy: Primarily considered for:
  • Short (typically <1-2 cm), soft, bulbar urethral strictures (in the bulb of the penis).
  • First-time strictures.
  • Patients who are not candidates for more extensive open surgery due to comorbidities.
  • Diagnosis: In Korea, diagnosis involves a physical exam, urinalysis, uroflowmetry (to measure urine flow rate), and imaging like retrograde urethrography (RUG) or cystoscopy (endoscopic visualization).


Common Surgical Procedure in Korea

Urethrotomy is typically performed as an endoscopic procedure.

  • Procedure:
  1. Anesthesia: Usually performed under general or spinal anesthesia.
  2. Cystoscope Insertion: A thin, rigid telescope (cystoscope/urethroscope) is inserted into the urethra to visualize the stricture.
  3. Incision: A small knife (cold knife) or laser attached to the cystoscope is used to cut through the scar tissue of the stricture, widening the urethral lumen. The incision is often made at the 12 o'clock position (roof of the urethra).
  4. Catheter Placement: A urinary catheter is typically left in place for a few days to several weeks after the procedure to keep the urethra open during the initial healing phase.
  • Mechanism: The procedure physically incises the scar tissue, releasing the narrowing and allowing the urethra to expand.
  • Duration: The surgery is relatively quick, often taking 15-30 minutes.


Recovery & Outcomes in Korea

Recovery is generally short, but a significant challenge with urethrotomy is the potential for stricture recurrence.

  • Post-Procedure: Patients may experience temporary burning, discomfort during urination, and blood in the urine for a few days. Pain is usually mild and managed with oral medication.
  • Activity: Most patients can resume light activities within a few days. Strenuous activities are typically restricted for a few weeks.
  • Recurrence Rate: While effective in the short term, urethrotomy has a notable recurrence rate, particularly for longer strictures, penile strictures, or after multiple previous dilations/urethrotomies. Long-term success rates can range from 30% to 70%, with higher rates for first-time, short, bulbar strictures.
  • Follow-up: Regular follow-up with the urologist, including uroflowmetry, is crucial to monitor for recurrence.
  • Self-Catheterization: Some patients may be advised to perform clean intermittent self-catheterization (CISC) periodically after surgery to help maintain the urethral opening and reduce the risk of re-stricturing.


Korean Guidelines & Practice

Korean urologists consider urethrotomy a viable initial option for specific types of strictures.

  • Initial Approach: Often chosen as a first-line, less invasive treatment due to its simplicity and quicker recovery compared to open surgery.
  • Role in Management: It is part of a stepwise approach to urethral stricture disease. For recurrent or more complex strictures, Korean urologists will typically discuss more definitive and durable solutions like urethroplasty.
  • Patient Counseling: Patients are thoroughly counselled about the risk of recurrence and the potential need for subsequent procedures.
  • National Health Insurance: Urethrotomy for medically indicated urethral strictures is generally covered by Korea's national health insurance.


Key Takeaways for Urethrotomy in Korea

To summarize the essential points about Urethrotomy in Korea:

  • Treats Urethral Strictures: Involves endoscopically cutting scar tissue to widen the urethra.
  • Minimally Invasive: A quick outpatient or short-stay procedure with relatively fast initial recovery.
  • Recurrence is Common: Effective for immediate relief, but strictures frequently recur, especially after initial treatment.
  • Initial Treatment Option: Often considered for short, simple strictures before more definitive surgical options like urethroplasty.

We hope this guide clarifies Urethrotomy in Korea. Always consult a qualified medical professional for personalized advice, diagnosis, and treatment options for urethral strictures.