Urethroplasty

What is urethroplasty?

Urethroplasty is reconstructive surgery for treatment of urethral stricture disease (scarring and narrowing of the urethra). It is performed when urethral strictures recur despite dilatation and incision.

How is it performed?

An incision is made between the scrotum and the anus to allow the surgeon access to the urethra. The urethra is then fully dissected out around stricture.

Several reconstructive techniques are available for reconstruction of urethral strictures. The technique used depends on the length and location of the urethral stricture. The surgeon may decide at the time of surgery which technique is the most appropriate.

Two main techniques are:

Non-sectioning Anastomotic Repair

This is suitable for a short segment of urethral stricture at the bulbar segment of the urethra. This is the segment of urethra inside the pelvis, and the most common location for urethral strictures to form. The urethra is not fully divided if possible to preserve the blood supply which runs in the bulbo spongiosum around the urethra. The diseased segment of urethra is removed and the healthy part of the urethra is reconnected over a catheter.

Substitution Repair

For long strictures and strictures located in the penis urethra, a graft is placed at the stricture site to widen the urethra. Generally, the best source of the graft is the buccal mucosa which lines the inside of the mouth. The graft is sutured on to the penile tubes (corpora cavernosum) to allow the graft to live on its surface and take up a blood supply.

Urethroplasties are very successful, with a success rate of > 90%.

What to expect after urethroplasty?

After the surgery, you will wake up with a urinary catheter tube placed in the bladder through the urethra. This will stay in the urethra for around 10 days to allow the urethra to fully heal up around the catheter.

You should be able to eat and drink normally and get up and walking the next day.

You will likely be discharged day 2 or day 3 after the operation depending on how comfortable you are. You will return home with the catheter in place. A catheter bag will be strapped to the leg, so you will still be able to move around without too much inconvenience.

You will return to hospital 10 days after the operation for a dye test to confirm the waterpipe is fully healed on the inside before the catheter is removed.

You’ll need to resume your activity level gradually. You should be back to your normal routine in about four weeks.

You won’t be able to drive for approximately two weeks after going home. Don’t drive until your catheter is removed, you are no longer taking prescription pain medications and your doctor says it’s OK.