Dr. Anupam Bhargava, Chairman, Urology, Max Smart Super Speciality Hospital, Saket, tells us how a young man came to him with a tube inserted in his bladder and how he was helped with a procedure called “Optical Urethrotomy”.
A young man came to me with a tube inserted in his urinary bladder through his lower abdominal wall. He was having this tube for the last three years as he could not pass urine through the normal urinary passage. This happened after a road traffic accident where his urinary tube got damaged.
He was subjected to some investigations. After getting some coloured X-rays done, I found out that his urinary tube was damaged for a length of about two inches.
I gave him two options. One was a cure and the other was only a treatment. The difference was that after a treatment he had to come for dilating the tube on regular basis or else he has to do it himself to dilate. The cure was that he did not require coming for further treatment for this urinary passage injury.
The treatment I offered was going through his urinary passage and cutting the narrow segment with a LASER. A tube had to be left in the passage for a week and then removed. The problem was that the narrowness recurs after few weeks, which requires recurrent dilations. He asked me the problems of recurrent dilations. I explained to him about recurrent urinary tract infection and there could be a possibility that any time injury may take place. He was discouraged on listening to this treatment and asked me about other option.
I informed him of the other option. The cure can be achieved by undergoing an open operation. In this operation, a thin skin is taken out from inside of the cheek and darned at the narrow segment of the urinary tube. The operation may last for two hours. The hospital stay is for five days or so. He will go home on the catheter and it will be removed after two weeks. The recurrence is extremely low. He was satisfied with the second option. He underwent this surgery. It is more than two years after the operation and he is doing well. Now married and having a normal life.
The operation done with LASER is called Optical urethrotomy. The operation where we take the skin patch is called Substitution Urethroplasty.
Dr. Anupam Bhargava has performed several Substitution Urethroplasties and the patients are doing exceedingly well.