Details

Key Benefits

The new urethrotome allows for easy and safe non-visual internal urethrotomy by passage over a guidewire, no moving parts and cutting of only fibrous scar. The flat blade protects normal urethra, which is pushed gently away during passage.

Method of Use

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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 12-26 F urethrotome may have a stricture reducing benefit prior to TURP as shown by Schultz et al in their article.
The urethrotome can also be used to enlarge a suprapubic tract over a guide wire as well as a nephrostomy tract. References below.
References:
Prevention of urethral stricture formation after transurethral resection of the prostate: A controlled randomized study of Otis urethrotomy versus urethral dilation and the use of the polytetrafluoroethylene coated versus the insulated metal sheath. Schultz A, Bay-Nielsen H, Bilde T, et al.  Journal of Urology. 1989;141(1):73-75. http://www.ncbi.nlm.nih.gov/pubmed/2642313
Suprapubic tract dilation using the Otis urethrotome. Thrasher JB, Kreder KJ. Urology. 1993 Mar; 41(3):247-8. http://www.ncbi.nlm.nih.gov/pubmed/8442308
Percutaneous nephrostomy tract incision using a modified Otis urethrotome. Ireton RC. Urology Clinics of North Am. 1990 Feb; 17(1):195-8 
http://www.ncbi.nlm.nih.gov/pubmed/2305529

 

Features

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  • Surgical steel
  • Flexible stem with tactile feedbackcharacteristics
  • No sharp edges to come in contact withnormal tissue
  • Central hole for passage over a guidewire
  • “Cm” markings on the stem of the instrumentto help assess the depth of the stricture. “Double” markings at 5, 10 and 15 cm

Technical Aspects

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The design of the internal urethrotome has a conical shape in three different sizes: 8 – 14 F, 10 – 20 F and 12 – 26 F (Fig 1). There is a blade arising on one side from a recessed surface within the cone, which does not exceed the circumference of the cone (Fig 2). The blade has a flat surface, which does not cut normal tissue, but sharp square edges, which will cut fibrotic tissue when engaged by a tight stricture. The conical head of the urethrotome has a channel running through its center for passage over a guidewire, which allows blind passage to the stricture and thus minimizing trauma from blind passage (Fig 3).

 

  

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