Urethraloscopy

At a Urethraloscopy the doctor inserts an endoscope into the urethra. This allows him to look at and examine the urethra.

What is a urethraloscopy?

During a urethraloscopy, the doctor inserts an endoscope into the urethra. This allows him to look at and examine the urethra.

With the urethraloscopy, the attending physician, usually the urologist, has the opportunity to find pathological changes in the urethra. The technical term for the mirroring of the urethra is Urethroscopy.

A urethroscopy is performed, for example, in the case of blood in the urine (hematuria), urinary incontinence, pain in the lower abdomen, or recurring urinary tract infections. If necessary, small interventions can be carried out under local anesthesia as part of the examination. The urethraloscopy as an examination procedure is similar to the cystoscopy procedure. However, the focus of the examination is on the urethra, not the bladder. Often, however, both examination methods are carried out one after the other. Basically, the urethral examination is a straightforward diagnostic method that can be performed within a few minutes.

Function, effect & goals

During a urethraloscopy, 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 examination of the patient takes place 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 device and an optic. The flexible cystoscope consists of only one part. The shaft is flexible and equipped with a controllable and also very flexible tip. There is a lens at the tip of the flexible cystoscope. This is connected to the eyepiece via glass fibers. Inside the cystoscope is a combination of working channel and irrigation channel. A local anesthetic is almost always performed before the urethraloscopy.

Upon express request, the examination can also be carried out under general anesthesia. For local anesthesia, the attending physician applies lubricant gel with anesthetic to the beginning of the urethra. The urethral entrance is then thoroughly cleaned. As soon as the numbing gel takes effect, the doctor carefully inserts the cystoscope into the urethra while rinsing with water. Here he looks closely at the structure of the urethra. He pays attention to constrictions (strictures), changes in the epithelium or tumors. Inflammation can also be diagnosed based on redness or swelling on the wall of the urethra.

Urethroscopy is indicated if there is blood in the urine. Hematuria can indicate inflammation of the kidneys, urinary bladder, or urethra. A tumor in the urethra can also cause blood in the urine. Urinary incontinence is also an indication for a mirror image of the urethra. The same goes for recurring urinary tract infections. Constantly recurring bladder infections or renal pelvic infections can be caused by 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 known as strictures. Strictures can lead to painful urination. They can be easily diagnosed with the help of a urethral examination. In addition, short constrictions during the mirror can be treated immediately under local anesthesia. The endoscopic slitting procedure is used for this. However, longer or pronounced cicatricial strictures must be performed in the hospital under general anesthesia.

The urethra can not only be narrowed by scarred changes, an enlarged prostate can also narrow the man's urethra. The prostate surrounds the urethra so that when it enlarges it presses on the urethra. This leads to urination problems.

The urethraloscopy 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 a protrusion of the urethra. Urine can collect in this sac, which can quickly lead to inflammation. Urethral diverticula can be identified and flushed out during urethroscopy. With the help of the urethral examination, foreign bodies and tumors in the urethra can also be reliably detected.

Risks, side effects & dangers

A urethraloscopy should not be performed if the prostate, bladder, or urethra is acutely inflamed. Therefore, a urine test must be carried out before every urethroscopy so that a urinary tract infection can be excluded.

Urethroscopy is actually a straightforward procedure. Even so, complications can arise in some cases. After the examination, a urinary tract infection can develop through introduced pathogens. In addition to inflammation of the urethra, inflammation of the kidneys or the prostate can also occur. The urethra can be injured through the endoscope. This results in pain and discomfort when urinating. A combined examination of the urethra and urinary bladder can also injure the sphincter muscle of the bladder or the bladder itself. A lesion of the sphincter muscle can cause temporary incontinence.

Occasionally, symptoms such as burning sensation when urinating or blood in the urine occur after the urethraloscopy. Usually these symptoms can be traced back to the mechanical irritation of the tissue inside the urethra. Thus, these complaints 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 immunocompromised patients. People with metabolic diseases such as diabetes mellitus are also more likely to suffer infections after a urethral examination. In order to prevent infection, risk groups are therefore often given an antibiotic as a preventative measure.