What is a urethroplasty?
Urethroplasty is surgery performed on your urethra, a part of your urinary system. The urethra is a tube that carries urine from your urinary bladder
to the outside of your body. In men, the urethra also carries semen outside of their bodies.
Why is a urethroplasty done?
Urethroplasty is done to repair or replace your urethra when scar tissue forms inside it. Your surgeon connects two ends of your urethra after
cutting out the scar tissue, or may borrow tissue elsewhere in your body to rebuild the portion of your urethra that’s blocked.
You may need urethroplasty if:
- You have a urethral stricture. This means that some part of your urethra has become narrower, blocking the flow of urine.
Urinary strictures are much more common in men than women.
- You have epispadias or hypospadias, congenital conditions that affect your urethra, which were repaired in childhood.
Blockages are especially common in urethras that have previously been rebuilt.
Is urethroplasty considered major surgery?
The length of time surgery lasts depends on how much repair work is being done. For instance, a repair that joins two ends of your urethra together takes
less time than a repair that requires tissue from another place in your body. If your entire urethra is involved, multiple pieces of tissue can be
needed to rebuild the urethra.
What happens before a urethroplasty?
The length and location of the blockage are typically confirmed by an X-ray called a retrograde urethrogram, or cystoscopy.
Both are very quick and minimally painful procedures done in your healthcare provider’s office. Before the day of the surgery,
your healthcare provider will give you instructions on what and when you can eat or drink and what to do about any medications you take.
Your healthcare provider may suggest you have a suprapubic catheter placed before your surgery to allow your bladder to be emptied and your
urethra time to “rest” so scar tissue can declare itself (and thus be fixed) prior to surgery. This is usually recommended if you
require self-catheterization to keep the blockage open. These types of catheters are placed directly into your bladder from the pubic
area (just above the pubic bone).
You’ll remove your jewelry, change into a hospital gown and then go to the operating suite.
You’ll be given general anesthesia to put you into a deep sleep.
What happens during a urethroplasty?
Your surgeon will cut into your muscle tissue to reach your urethra. The incision is typically either on the underside of your penis, in your
scrotum or (most commonly) between your scrotum and anus (perineum). The location of the stricture is identified and either removed, or that
section is rebuilt depending on its length and location.
If the blockage is longer, or located in the penile urethra, the surgeon will harvest your mouth, genital or rectal tissue to
supplement the incised (cut away) tissue from your urethra. The incision is then closed, and usually, a small drain is placed for a
day or so. You’ll have a catheter to allow the urethra to heal while urine is still able to leave your body. Your muscle and skin will
be closed up with stitches that are absorbed by your body — you don’t have to get them taken out.
What happens after a urethroplasty?
You’ll spend some time in the recovery room, to come out of the anesthesia. You’ll need to have someone drive you home if you’re having
urethroplasty as an outpatient procedure. Most people either go home the same day or stay one night in the hospital.
You’ll be sent home with a urinary catheter, pain medication, antibiotics and possibly medication to prevent bladder spasms.
You might also be given medication to stop you from having erections. If tissue from your mouth is used to reconstruct your urethra,
you may have a special mouth wash to keep the area clean.
After urethral reconstruction, you’ll have an appointment with your healthcare provider about two to three weeks after surgery.
At that time, you might have a radiology procedure to check the area of repair if you haven’t had one before this visit.
If you need the procedure, the radiologist will fill your bladder with contrast, remove the catheter and take X-rays while you urinate.
You’ll then meet with your clinical team, who’ll review these images.
What are the advantages of urethroplasty?
Research indicates that urethroplasty is the best way to treat urethral strictures so urine can flow freely.
The success rate is fairly high at over 80%. In some cases, depending on the location and length, the success rate is reliably higher than 90%.
What are the risks or complications of urethroplasty?
Every procedure carries risks, with problems with anesthesia and possible infections common to any surgery