Urethroscopy: Treatment, Effect & Risks

During a urethroscopy, the doctor inserts an endoscope into the urethra. This allows him to view and examine the urethra.

What is a urethroscopy?

During a urethroscopy, the doctor inserts an endoscope into the urethra. This allows him to view and examine the urethra. During urethroscopy, the attending physician, usually the urologist, has the opportunity to find abnormal changes in the urethra. The technical term for urethroscopy is urethroscopy. A urethroscopy is performed, for example, in case of blood in the urine (hematuria), urinary incontinence, pain in the lower abdomen or recurrent urinary tract infections. If necessary, minor procedures can be performed under local anesthesia as part of the examination. Urethroscopy as an examination procedure is similar to the procedure of cystoscopy. However, the focus of the examination is on the urethra and not on the bladder. However, both examination methods are often performed consecutively. Basically, urethral examination is an uncomplicated diagnostic method that can be performed within a few minutes.

Function, effect and goals

During urethroscopy, an endoscope is inserted into the urethra. In men, access is through the glans, in women through the vagina. A so-called cytoscope is used for the examination. The patient is examined while lying down. Basically, two different types of cystoscopes can be used. The rigid cystoscope is a multi-part instrument made of metal. It is divided into an outer shaft, a so-called obturator, a working instrument and an optical system. The flexible cystoscope consists of only one part. The shaft is flexible and equipped with a steerable and also very flexible tip. At the tip of the flexible cystoscope there is a lens. This is connected to the eyepiece via optical fibers. Inside the cystoscope is a combination of working channel and irrigation channel. Local anesthesia is almost always administered prior to urethroscopy. If specifically requested, the examination can also be done under general anesthesia. For local anesthesia, the attending physician applies a lubricating gel with anesthetic to the beginning of the urethra. The entrance to the urethra is then thoroughly cleaned. As soon as the anesthetic gel takes effect, the doctor carefully inserts the cystoscope into the urethra while rinsing it with water. Here he takes a close look at the structure of the urethra. He looks for narrowing (strictures), epithelial changes or tumors. Inflammations can also be diagnosed on the basis of redness or swelling on the wall of the urethra. Urethroscopy is indicated if there is blood in the urine. Hematuria may indicate inflammation of the kidneys, bladder, or urethra. A tumor in the urethra can also cause blood in the urine. Urinary incontinence is also an indication for urethral endoscopy. The same is true for recurrent urinary tract infections. Constantly recurring bladder infections or renal pelvic inflammation may be due to a chronic focus of inflammation in the urethra. Chronic inflammation or injury to the urethra can cause scarring in the urethra. Scarring can cause the urethra to narrow. These narrowings are also called strictures. Strictures can cause pain when urinating. They can be easily diagnosed with the help of urethroscopy. In addition, short-stretch strictures can be treated immediately during the endoscopy under local anesthesia. The endoscopic slitting procedure is used for this purpose. Longer or pronounced scarred strictures, however, must be performed in the hospital under general anesthesia. However, the urethra may not only be narrowed by scarring changes; an enlarged prostate can also narrow the male urethra. The prostate gland surrounds the urethra so that it presses on the urethra when enlarged. This causes problems with urination. Urethroscopy is also used therapeutically for urethral diverticula. Urethral diverticula are also known as paraurethral cysts. Most often, women are affected by this condition. A urethral diverticulum is an outpouching of the urethra. Urine can accumulate in this bulge, so that inflammation can quickly develop there.Urethral diverticula can be detected and flushed out during urethroscopy. With the help of urethroscopy, foreign bodies and tumors in the urethra can also be reliably detected.

Risks, side effects, and hazards

Urethroscopy should not be performed if the prostate, bladder or urethra are acutely inflamed. Therefore, a urine check must be performed before any urethroscopy so that a urinary tract infection can be ruled out. Urethroscopy is actually an uncomplicated procedure. Nevertheless, complications can occur in some cases. For example, a urinary tract infection can develop after the examination due to introduced pathogens. In addition to inflammation of the urethra, inflammation of the kidneys or prostate can also develop. The urethra can be injured by the endoscope. This results in pain and discomfort during urination. In addition, when the urethra and bladder are examined together, the sphincter of the bladder or the bladder itself may be injured. A lesion of the sphincter may result in temporary incontinence. Occasionally, symptoms such as burning during urination or blood in the urine occur after urethroscopy. Normally, these symptoms can be attributed to the mechanical irritation of the tissue inside the urethra. Thus, these symptoms are considered harmless and disappear on their own within a short time. If the symptoms persist, the attending physician must be informed. The risk of infection is increased in immunosuppressed patients. People with metabolic diseases such as diabetes mellitus are also more likely to suffer infections after a urethroscopy. Therefore, to prevent infection, high-risk groups often receive an antibiotic as a preventive measure.

Typical and common urethral diseases