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.
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 

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