Use of a Small-Diameter Resectoscope on a Patient with Extensive Urethral Strictures for Transurethral Resection

This case refers to a 60-year-old male suffering from an extensive circular urethral stricture throughout the whole length of the urethra, with the coexistence of a papillomatous tumor of the urinary bladder. The insertion of the resectoscope through the urethra was impossible, despite previous dilations with Benique. Therefore, an internal urethrotomy was performed. From May 2020 to September 2022, the patient was submitted to three TUR-BTs with the use of a smaller diameter resectoscope (22ch). The histology report resulted in TCC (Transitional Cell Carcinoma) stage pT1 high grade. The patient was then administered intravesical bacillus Calmette-Guerin installations. The last TUR-BT took place in October 2022. It was impossible to insert the conventional 22ch resectoscope through the urethra, so the Delmont gynecological resectoscope was used instead. This resectoscope by the French company Delmont has the same length as the conventional urological resectoscopes, but the important fact is its smaller diameter (18, 5 ch), allowing the surgeon to pass through the urethra and approach the papillomatous lesion in the bladder. The lesion was resected transurethrally, and the histological examination resulted in TCC with focal infiltration of the muscle layer, stage pT2 high grade. In this way, it was possible to complete the surgical procedure in a case that the conventional resectoscope could not enter the urethra, and the outcome was exceptional. In November 2022, following the Oncology–Urology Council of the hospital, it was decided for the patient to receive neoadjuvant chemotherapy followed by radical cystoprostatectomy.