Urethroplasty is a surgery where the urethra is reconstructed to cure problems like urethral strictures. The types of surgeries are varied and depend upon the location, cause, and length of the stricture. Most surgeries take between three to six hours to complete.
An incision is made over the area of the stricture in the penis, scrotum, or perineum (the area between the scrotum and the anus). After surgery, a urethral catheter is left in for two to four weeks depending upon the type of surgery that was performed. When patients return to clinic the bladder is filled with x-ray contrast and the catheter is gently removed.
While x-rays are being taken, the patient voids and the area of the surgery is evaluated. If the area of surgery is healed, then the catheter is left out and patients begin to void normally
Types of operations
The choice of procedure is dependent on factors including
- physical condition of the patient
- overall condition of the remainder of the urethra (not affected by the stricture)
- the length of the defect (best determined by urethrography)
- multiple or misaligned strictures
- anatomical positioning of the defect with regard to the prostate gland, Urinary sphincter, and ejaculatory duct
- position of the most patent area of the urethral wall (necessary for determination of the location of the onlay/graft site, most often dorsal or ventral)
- complications and scarring from previous surgery(ies), stent explantation (if applicable), and the condition of the urethral wall
- availability of autografttissue from the buccal cavity. (buccal mucosa) (primary selection)
- availability of autografttissue from the penis and scrotum (secondary selection)
- skill level and training of the surgeon performing the procedure
Pre-OP for Urethroplasty?
The normal pre-surgical testing/screening (per the policies of the admitting hospital, anesthesiologist, and urological surgeon) will be performed, and the patient will be advised to ingest nothing by mouth, “NPO”, for a predetermined period of time (usually 8 to 12 hours) prior to the appointed time.
Upon arrival to the preoperative admitting area, the patient will be instructed to don a surgical gown and be placed into a receiving bed, where monitoring of vital signs, initiation of a normal saline IV drip, and pre-surgical medication including IV antibiotics, and a benzodiazepine class sedative, usually diazepam or midazolam will be started/administered.
What is a Urethroplasty?Urethroplasty procedure
The procedures for induction of the type of anesthesia chosen by both the patient and medical staff will be started.
Urethroplasty is the repair of an injury or defect within the walls of the urethra. Trauma, iatrogenic injury and infections are the most common causes of urethral injury/defect requiring repair. Urethroplasty is regarded as the gold standard treatment for urethral strictures and offers better outcomes in terms of recurrence rates than dilatations and urethrotomies. It is probably the only useful modality of treatment for long and complex strictures though recurrence rates are higher for this difficult treatment group.
With an average operating room time of between three and eight hours, urethroplasty is not considered a minor operation. Patients who undergo a shorter duration procedure may have the convenience of returning home that same day (between 20% and 30% en total of urethroplasty patients). Hospital stays of two or three days duration are the average. More complex procedures may require a hospitalization of seven to ten days.
Post-OP for Urethroplasty
When strictures come back after surgery they often are thin and web-like. These strictures can cause obstruction but often can be treated internally by cutting the stricture with a scope procedure. This is not similar to the initial stricture that often has too much scarring to respond long-term to an internal cutting procedure. Some strictures are too dense and do not respond to internal cutting and the patient may need further surgery.
The follow-up after urethroplasty is very important; this is because most urethral strictures recur within the first year or two after surgery. Patients are seen every three to six months in their first year after surgery.
At the first appointment patients undergo cystoscopy of the urethra in the office and the urinary flow rate and residual urine is measured in our office. Cytoscopy is a scope exam of the urethra where a small scope is placed into the urethra from the penis, very similar to catheterization, and the area of the surgery is examined for recurrent strictures.
Side effect Urethroplasty
- recurrence of the stricture
- urinary incontinence (symptoms of incontinence often improve over time with strengthening exercises)
- urinary retention requiring intermittent catheterization to completely empty the urinary bladder
- erectile dysfunction
- loss of penile sensation, decreased tactile sensation of the penile shaft and corona
- retrograde ejaculation, changes in ejaculation, and decrease in intensity of orgasm
- referred pain
- urinary fistula
- urinary urgency
- urine spraying
- external bleeding (from the suture line(s))
- bleeding from the internal suture lines (seen as bloody discharge from the urethra)