Department of Urology Surgical procedure information leaflet

Transcription

1 Department f Urlgy Surgical prcedure infrmatin leaflet Name f prcedure: Optical Urethrtmy An Optical Urethrtmy is a prcedure fr pening up a stricture (narrwing) in the urethra (water pipe). A urethral stricture is the medical name fr a ring f scar tissue surrunding the urinary passage frm the bladder. Althugh urethral strictures can ccur anywhere frm the bladder t the external pening f the water pipe, the mst cmmn places are at the base f the penis and als just inside the water pipe. The stricture cnsists f scar tissue. This is cut internally, using a blade r laser, with the use f a special telescpe which is passed dwn the penis. The peratin is usually perfrmed under a general anaesthetic and takes minutes. What causes a urethral stricture? In years gne by, urethral strictures were usually caused by infectin but tday, mst are caused by injury, smetimes because f side effects f an examinatin r treatment that invlves the urinary tract. Any damage can lead t the build-up f scar tissue which can cause prblems passing urine. They can ccur at any age and it is pssible t have mre than ne stricture. What are the Symptms? The symptms may be varied but can include the fllwing: Reduced urine flw, straining t pass urine Spraying f urine r a duble stream may ccur Dribbling f urine after the main flw has finished Needing t pass urine mre ften than usual Pain n passing urine can smetimes ccur This leaflet explains sme f the benefits, risks and alternatives t the peratin. We want yu t have all the infrmatin yu need t make the right decisin. Please ask yur surgical team abut anything yu d nt fully understand r want t be explained in mre detail. We recmmend that yu read this leaflet carefully. Yu and yur dctr (r ther apprpriate health prfessinal) will als need t recrd that yu agree t have the prcedure by signing a cnsent frm, which yur health prfessinal will give yu. Surgical infrmatin prcedure leaflet 1 f 8 Versin 1.6 Optical Urethrtmy Expiry date: 24/05/2017

2 Benefits f the prcedure The main purpse f the peratin is t relieve urinary bstructin and imprve the urinary flw. Fr mst patients this will prvide a cure r a significant imprvement in urinary symptms. Risks f Leaving a Stricture Untreated Everything we d in life has risks. Mre pressure is needed frm the bladder muscle t pass urine ut thrugh a stricture (it acts like a bttleneck). Nt all urine in the bladder may be passed when yu g t the tilet. Sme urine may pl in the bladder. This 'residual' pl f urine is mre likely t becme infected. This makes yu mre prne t bladder, prstate and kidney infectins. An abscess (ball f infectin) abve the stricture may als develp. This can cause further damage t the urethra and tissues belw the bladder. Cancer f the urethra is a rare cmplicatin f a lngstanding stricture. Surgery t pen up the stricture is usually a very safe peratin. Occasinally cmplicatins can arise because f the invasive nature f the prcedure. The general risks f surgery include prblems with: breathing (fr example, a chest infectin); the heart (fr example, abnrmal rhythm r, ccasinally, a heart attack); and bld clts (fr example, in the legs r ccasinally in the lung). Strke Death Thse specifically related t Optical Urethrtmy include: Cmmn risks (Greater than 1 in 10): Mild burning r bleeding n passing urine fr a shrt perid after the peratin. Recurrence f the stricture. Fr this reasn yu may be taught t self-dilate the stricture with a catheter. If the dctr feels this is a suitable treatment yu may be taught befre leaving hspital. N guarantee f stricture cured by this peratin alne. Occasinal risks (Between 1 in 10 and 1 in 50): Infectin f the bladder requiring antibitics Permissin fr telescpic remval r bipsy f any bladder abnrmality r stne, if fund Rare risks (Less than 1 in 50): Delayed bleeding requiring remval f clts r further surgery. Damage t the drainage tubes frm the kidneys (ureters) requiring additinal therapy. Injury t the urethra causing delayed scar frmatin Perfratin f the bladder requiring a temprary catheter r pen surgery repair. Decrease in the quality f erectins Hspital-acquired infectin Clnisatin with MRSA (0.9% - 1 in 110). MRSA bldstream infectin (0.02% - 1 in 5000). Clstridium difficile bwel infectin (0.01% - 1 in 10,000). Surgical infrmatin prcedure leaflet 2 f 8 Versin 1.6 Optical Urethrtmy Expiry date: 24/05/2017

3 The rates fr hspital-acquired infectin may be greater in high-risk patients, fr example thse patients with lng-term drainage tubes; wh have had their bladder remved due t cancer; wh have had a lng stay in hspital; r wh have been admitted t hspital many times. Mst peple will nt experience any serius cmplicatins frm their surgery. The risks increase fr elderly peple, thse wh are verweight and peple wh already have heart, chest r ther medical cnditins such as diabetes r kidney failure. As with all surgery, there is a risk that yu may die. Yu will be cared fr by a skilled team f dctrs, nurses and ther health-care wrkers wh are invlved in this type f surgery every day. If prblems arise, we will be able t assess them and deal with them apprpriately. Yur pre-perative assessment Befre yu are admitted fr yur peratin, yu may be required t attend fr a pre-perative assessment, t ensure that yu are fit fr surgery. It is imprtant that yu attend fr this appintment t avid delaying yur surgery. Nt all patients require a detailed pre-perative assessment and a health questinnaire is used t determine which patients require a full assessment. Yu may therefre be asked t cmplete a health questinnaire immediately after yu have been listed fr yur surgery. The health questinnaire may be n paper r n a tablet/cmputer. The infrmatin required includes all medical cnditins, regular medicatins, allergies t medicatins and yur previus anaesthetic histry. The infrmatin yu give us will be reviewed by the pre-perative assessment team. If yu d nt require further assessment yu will then be given a date fr surgery. If yu require further assessment yu will be given an appintment t attend the pre-perative assessment clinic. At the clinic, the nursing staff will cnfirm the medical infrmatin yu have previusly given. Yu will likely have an examinatin f yur heart and lungs and sme further tests may be required, such as a bld test, X-ray, heart test r lung test. If a mre detailed assessment r discussin is required yu may see an anaesthetist prir t yur admissin fr surgery. This may require an additinal appintment. If yu are taking prescribed medicines please bring a cpy f yur repeat prescriptin t yur appintment and a cpy f the peratin cnsent frm (if yu were prvided with a cpy at yur ut-patient appintment). Fllwing yur assessment, the staff will prvide yu with written infrmatin regarding preparatin fr yur surgery and a pint f cntact. It is imprtant that yu fllw the fasting instructins given n yur admissin letter. Being admitted t the ward Yu will usually be admitted n the day f yur surgery. Yu will be welcmed n t the ward and yur details checked. We will fasten an armband cntaining yur hspital infrmatin t yur wrist. Yu will usually be asked t cntinue with yur nrmal medicatin during yur stay in hspital, s please bring it with yu, in the green bag prvided fr yu at pre-perative assessment. Yur anaesthetic Yur surgery will usually be carried ut under a general anaesthetic. This means that yu will be asleep during yur peratin and yu will feel nthing. Befre yu cme int hspital There are sme things yu can d t prepare yurself fr yur peratin and reduce the chance f difficulties with the anaesthetic. Surgical infrmatin prcedure leaflet 3 f 8 Versin 1.6 Optical Urethrtmy Expiry date: 24/05/2017

4 If yu smke, cnsider giving up fr several weeks befre the peratin. Smking reduces the amunt f xygen in yur bld and increases the risks f breathing prblems during and after an peratin. If yu are verweight, many f the risks f anaesthesia are increased. Reducing yur weight will help. If yu have lse r brken teeth r crwns that are nt secure, yu may want t visit yur dentist fr treatment. The anaesthetist will usually want t put an airway in yur muth t help yu breathe. If yur teeth are nt secure, they may be damaged. If yu have lng-standing medical prblems, such as diabetes, hypertensin (high bld pressure), asthma r epilepsy, yu shuld cnsider asking yur GP t give yu a check-up. If yu becme unwell r develp a cugh r cld the week befre yur surgery please cntact the preperative assessment team n the number prvided. Depending n yur illness and hw urgent yur surgery is, we may need t delay yur peratin as it may be better fr yu t recver frm this illness befre yur surgery. Yur pre-surgery visit by the anaesthetist After yu cme int hspital, the anaesthetist will cme t see yu and ask yu questins abut: yur general health and fitness; any serius illnesses yu have had; any prblems with previus anaesthetics; medicines yu are taking; allergies yu have; chest pain; shrtness f breath; heartburn; prblems with mving yur neck r pening yur muth; and any lse teeth, caps, crwns r bridges. Yur anaesthetist will discuss with yu the different methds f anaesthesia they can use. After talking abut the benefits, risks and yur preferences, yu can then decide tgether what is best fr yu. On the day f yur peratin Nthing t eat and drink (nil by muth) It is imprtant that yu fllw the instructins we give yu abut eating and drinking. We will ask yu nt t eat r drink anything fr six hurs befre yur peratin. This is because any fd r liquid in yur stmach culd cme up int the back f yur thrat and g int yur lungs while yu are being anaesthetised. Yu may take a few sips f plain water up t tw hurs befre yur peratin s yu can take any medicatin tablets. Yur nrmal medicines Cntinue t take yur nrmal medicines up t and including the day f yur surgery. If we d nt want yu t take yur nrmal medicatin, yur surgen r anaesthetist will explain what yu shuld d. It is imprtant t let us knw if yu are taking anticagulant drugs (fr example, warfarin, aspirin, clpidgrel, persantin r dabigatran). Yur anaesthetic When it is time fr yur peratin, a member f staff will take yu frm the ward t the perating theatre. They will take yu int the anaesthetic rm and the anaesthetist will get yu ready fr yur anaesthetic. T mnitr yu during yur peratin, yur anaesthetist will attach yu t a machine t watch yur heart, yur bld pressure and the xygen level in yur bld. General anaesthetic Surgical infrmatin prcedure leaflet 4 f 8 Versin 1.6 Optical Urethrtmy Expiry date: 24/05/2017

5 General anaesthesia usually starts with an injectin f medicine int a vein. A thin plastic tube (venfln) will be placed in a vein in yur arm r hand and the medicines will be injected thrugh the tube. Smetimes yu will be asked t breathe a mixture f gases and xygen thrugh a mask t give the same effect. Pain relief after surgery Pain relief is imprtant t aid yur recvery frm surgery. This may be in the frm f tablets, suppsitries r injectins. Once yu are cmfrtable and have recvered safely frm yur anaesthetic, we will take yu back t the ward. The ward staff will cntinue t mnitr yu and assess yur pain relief. They will ask yu t describe any pain yu have using the fllwing scale. 0 = N pain 1 = Mild pain 2 = Mderate pain 3 = Severe pain It is imprtant that yu reprt any pain yu have as sn as yu experience it. What are the risks? The risk t yu as an individual will depend n whether yu have any ther illness, persnal factrs, such as smking r being verweight and surgery that is cmplicated r prlnged. General anaesthesia is safer than it has ever been. If yu are nrmally fit and well, yur risk f dying frm any cause while under anaesthetic is less than ne in 250,000. This is 25 times less likely than dying in a car accident. The side effects f having a general anaesthetic include drwsiness, nausea (feeling sick), muscle pain, sre thrat and headache. There is als a small risk f dental damage Yur anaesthetist will discuss the risks with yu and will be happy t answer any questins yu may have. After yur surgery Yu will be taken t the recvery rm t the general r day care ward. Yu will need t rest until the effects f the anaesthetic have wrn ff. Yu will have a drip in yur arm t keep yu well-hydrated. Yur anaesthetist will arrange fr yu t have painkillers fr the first few days after the peratin. Yu will be encuraged t get ut f bed and mve arund as sn as pssible, as this helps prevent chest infectins and bld clts. Yur surgical team will assess yur prgress and answer any questins yu have abut the peratin. Leaving hspital Length f stay Hw lng yu will be in hspital varies frm patient t patient and depends n hw quickly yu recver frm the peratin and the anaesthetic. Mst patients having this type f surgery will be in hspital fr ne day r an vernight stay. Afterwards After an Optical Urethrtmy yu may be required t be taught Intermittent Self Dilatatin. This invlves passing a lubricated catheter in and ut f yur urethra t stretch the area cncerned and help prevent it narrwing again. If yu require this, arrangements will be made fr yu t be taught it after yur dilatatin r urethrtmy. Yu will be asked t fllw a regimen which will be similar t this :- Dilate as instructed ONCE a day fr tw weeks then Dilate as instructed n ALTERNATE days fr tw weeks then Surgical infrmatin prcedure leaflet 5 f 8 Versin 1.6 Optical Urethrtmy Expiry date: 24/05/2017

6 Dilate as instructed ONCE a week carry n with this. Yu will be given a clinic appintment t review yur symptms. Medicatin when yu leave hspital Befre yu leave hspital, the pharmacy will give yu any extra medicatin that yu need t take when yu are at hme. Cnvalescence Hw lng it takes fr yu t fully recver frm yur surgery varies frm persn t persn. After yu return hme, yu will need t take it easy and shuld expect t get tired t begin with. During yur cnvalescence please remember the fllwing: Yu may ntice that yur urine lks slightly pink. This shuld clear in 1-2 weeks. Try and drink 2-3 litres f fluid a day until the bleeding has cleared. This will help clear the urine and keep it dilute. Yu may find that yu pass urine mre frequently fr the first week and it may sting when yu pass urine. If this des nt settle after 1 week please cntact yu GP. If yu have difficulty passing urine, the bleeding returns, r yu cannt pass urine please cntact yur GP. Persnal hygiene Yu will nrmally bathe r shwer while yu are in hspital, and this can cntinue as nrmal after yu leave hspital. Diet Yu dn t usually need t fllw a special diet. If yu need t change what yu eat, we will give yu advice befre yu g hme. Exercise We recmmend that yu avid strenuus exercise and heavy lifting fr up t 2 weeks. Yu shuld d lighter exercise, such as walking and light husewrk, as sn as yu feel well enugh. Sex Yu can resume yur usual sexual activity after 2 weeks. Driving Yu shuld nt drive until yu feel cnfident that yu culd perfrm an emergency stp withut discmfrt. This will prbably be at least 2 weeks after yur peratin. It is yur respnsibility t check with yur insurance cmpany. Wrk Hw lng yu will need t be away frm wrk varies depending n: hw serius the surgery is; hw quickly yu recver; whether r nt yur wrk is physical; and whether yu need any extra treatment after surgery. Mst peple will nt be fully back t wrk fr 3-4 weeks. Please ask us if yu need a medical sick nte fr the time yu are in hspital and fr the first three t fur weeks after yu leave. Cntact details Surgical infrmatin prcedure leaflet 6 f 8 Versin 1.6 Optical Urethrtmy Expiry date: 24/05/2017

7 If yu have any specific cncerns that yu feel have nt been answered and need explaining, please cntact the fllwing. Alexandra Hspital: Secretaries: Ward 10 Nursing Staff: r ext: r Ward 18 Nursing Staff: r ext: 42106/ Debbie Ralph, Urlgy Nurse Specialist: ext: Jackie Askew, Ur-nclgy Macmillan Nurse Specialist: ext: Kidderminster Hspital and Treatment Centre: Secretaries: Penny Templey, Urlgy Nurse Specialist Lead: Mary Symns, Nurse Specialist Survivrship Prgramme: Wrcestershire Ryal Hspital: Secretaries: Helen Wrth and Lisa Hammnd, Urlgy Nurse Specialists: Other infrmatin The fllwing internet websites cntain infrmatin that yu may find useful. Infrmatin fact sheets n health and disease Infrmatin leaflets by the Ryal Cllege f Anaesthetists abut 'Having an anaesthetic' On-line health encyclpaedia Infrmatin frm The British Assciatin f Urlgical Surgens Patient Services Department It is imprtant that yu speak t the department yu have been referred t (see the cntacts sectin) if yu have any questins (fr example, abut medicatin) befre yur investigatin r prcedure. If yu have any cncerns abut yur treatment, yu can cntact the Patient Services Department n The Patient Services staff will be happy t discuss yur cncerns and give any help r advice. If yu have a cmplaint and yu want it t be investigated, yu shuld write direct t the Chief Executive at Wrcestershire Acute Hspitals NHS Trust, Charles Hastings Way, Wrcester WR5 1DD r cntact the Patient Services Department fr advice. Please cntact Patient Services n if yu wuld like this leaflet in anther language r frmat (such as Braille r easy read). Bengali Urdu Surgical infrmatin prcedure leaflet 7 f 8 Versin 1.6 Optical Urethrtmy Expiry date: 24/05/2017

8 Prtuguese Plish Chinese Cmments We wuld value yur pinin n this leaflet, based n yur experience f having this prcedure dne. Please put any cmments in the bx belw and return them t the Clinical Gvernance Department, Finance Department, Wrcestershire Ryal Hspital, Charles Hastings Way, Wrcester, WR5 1DD. Name f leaflet: Date: Cmments: Thank yu fr yur help. Surgical infrmatin prcedure leaflet 8 f 8 Versin 1.6 Optical Urethrtmy Expiry date: 24/05/2017