Initially, after the instillation of an urethral anesthetic lubricant, a guide wire is passed into the urethra and through the stricture to the bladder. The urethrotome is loaded over the guidewire and slid gently to the stricture, which will be noted by increased resistance to the passage over the guide wire through the tactile feedback characteristic of the stem. Normal tissue is gently pushed out of the way. Markings on the stem will help localize the depth of the stricture from the meatus.
Advancing the urethrotome through the stricture will gently stretch fibrous bands, which will then be exposed to the sharp square edges of the urethrotome and divided as the urethrotome is advanced through the stricture. The 8-12 F and 10-20 F urethrotomes are enough for most strictures. They can also be used for bladder neck stenosis status post radical prostatectomy. The 12-26 F is designed to open up the urethra before a TUR if the urethra is too stenotic for the passage of a 26 F resectoscope.