Urethroplasty

Urethroplasty is surgery performed on the urethra, a part of the urinary tract system. The urethra is a tube which allows urine to exit from the bladder and travel outside it. Urethroplasty is performed to correct the narrowing of the urethra when scar tissue is formed inside your urethra. The surgeon connects two ends of the urethra after removing the scar tissue or may borrow graft tissue from other parts of your body to rebuild the portion of the urethra that is blocked.
The symptoms of the patients with urethral strictures usually are weak or fine urinary stream, forking or spraying of the stream, often accompanied by frequency and urgency. There may be irritation in the urethra. Urethral strictures may be complicated by infection (urine infection or infection locally in the urethra), urinary retention, peri urethral abscess, bladder and urethral stones and rarely squamous cell carcinoma of the urethra.



Indications

  • Urethral stricture: Urethral stricture means that some portion of your urethra is narrow, which blocks the flow of urine. Urinary strictures are more common in men than women.
  • Epispadias or hypospadias: These are congenital conditions that affect your urethra, which was repaired in childhood. Blockages are especially common in urethras that have previously been rebuilt.
  • Gender affirmation surgery
  • If less invasive treatments such as urethral dilatation, urethrotomy, or catheters have failed, a urethroplasty may be required.

Different types of urethroplasty

Anastomotic urethroplasty or Excision and primary anastomosis (EPA) urethroplasty

This type of surgery is best suited for short strictures located deep in the urethra, closer to the prostate in the bulbar or membranous urethra. A short segment of the bulbar urethra present between the scrotum and the prostate is removed and the cut ends of the urethra are sewn back together.

Graft Urethroplasty

The urethra can be enlarged with the help of a patch made of a piece of graft, usually taken from the extra-genital skin or buccal lining of the oral cavity(Buccal mucosal onlay graft).

Penile Flap Urethroplasty

A urethral stricture is repaired with a flap of the penile skin.

Staged Urethroplasty (Johanson's urethroplasty)

Surgically, the scarred urethra is removed and replaced with a buccal or skin graft. This artificial urethra heals over a few months; once healed, a second surgery forms the graft into a tube to reconstruct the urethra.


Procedure

Before the procedure

  • The urology team takes an X-ray of your urethra to locate the scar tissue. We may also evaluate your urinary tract through a uroflow test (to measure the flow and force of your urine) or cystoscopy.
  • You may be asked not to eat or drink after midnight on the day before the surgery.
  • You should inform the doctor if you are taking any pills which may interfere with your ability to clot your blood. Aspirin and other pain relievers or anti-inflammatory agents are the most common of these medications (prescription or over-the-counter).
  • You should avoid constipating foods such as rice, banana and red meat the entire week before the procedure. It is probably in your best interest not to strain your bowel movement in the week following the procedure. Consume plenty of fruits and vegetables, as well as oatmeal and cereals to avoid discomfort while you are healing. If you have any history of constipation, you should undergo an enema before going to bed the night before your procedure.
  • An IV (intravenous) line is placed in a vein in your arm or hand. This provides fluids and medication such as antibiotics.
  • You may be given medication to prevent blood clots.
  • You are given general anesthesia to keep you pain-free during the surgery. It puts you in a deep sleeplike state through the surgery. A tube may be inserted into your throat to help you breathe.

During the procedure

  • You will be positioned in a lithotomy position (i.e., lying down on your back with your legs separated, elevated, and supported).
  • A urethroplasty is most commonly performed through a perineum incision (the area between the scrotum and anus). In rare cases, it may be done through an incision in the lower abdomen. Combinations of the two incisions are occasionally used.
  • Once the urethra is approached and separated from surrounding tissue, dead scar tissue is removed.
  • In the case of short strictures, the two healthy ends may be anastomosed (sewn together) without much manipulation. In other situations, there are numerous surgical maneuvers the surgeon can use to close the ends. This is important so that there is no tension on the edges that are sewn together.
  • In rare instances, tissue may need to be harvested from other parts of the body(graft) to compensate for a large gap between the ends.
  • If the stricture is limited to the urethral opening in females, a flap of healthy vaginal skin can be made and sutured into the scarred tissue.
  • A catheter is placed across the repair and into the bladder. Once the urethral edges are repaired, the incisions are closed and a bandage is applied.

After the procedure

  • After the procedure, you will be in the recovery room until you are ready to be discharged home or admitted to the hospital. Your age, medical health condition, and the length of your procedure will decide whether or not you need to stay in the hospital.
  • It also varies depending on the surgery method, but generally hospitalization does not exceed more than 5 days. .
  • It is normal for you to feel a sense of urgency to urinate. This is from the procedure and the presence of the catheter. Most patients experience this for a couple of hours, though it can last until the catheter is withdrawn..
  • Patients rarely experience severe pain or swelling in the penis or scrotum.
  • The mouth is likely to be sore after the procedure if a graft is harvested from the inner side of the cheek lining (a buccal mucosa graft). The pain gradually fades slowly, with pain medication administered as needed
  • There are no dietary restrictions after surgery, and patients can immediately resume their normal eating habits.
  • Patients with buccal mucosa graft harvests prefer a soft diet because it may be sore inside the oral cavity.
  • Patients are encouraged to remain inactive for several weeks after being discharged to allow for proper recovery.
  • Catheters are often left in place for 2-3 weeks till voiding cystourethrogram (VCUG) examination. This is when the bladder is filled with X-ray contrast and a film is taken as the patient voids. When the urethra has healed completely, the patient can be "tube free" and resume normal urination.

Benefits and Risks

Benefits

  • Reduced risk of inflammation or infection of the testicles.
  • Reduced chances of recurrence of urethral stricture.
  • Improves the quality of life.

Risks

The risks associated with the urethroplasty procedure are:


Care at Medicover

Medicover Hospital is the one stop solution to diagnose and treat urological problems by utilizing the most advanced technology and equipment to ensure the safety of patients. The top notch urologists have the expertise to handle the most challenging and complex surgical cases by following evidence based protocols and providing the most successful outcomes.



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Frequently Asked Questions

1. Who performs urethroplasty?

The urologist performs urethroplasty.

2. What is the purpose of a urethroplasty?

Urethroplasty is a surgical procedure used to correct urethral narrowing caused by scarring. Urethroplasty for urethral reconstruction produces excellent and long-lasting results.

3. What not to do after urethroplasty?

It is vital to limit daily activities after urethroplasty until adequate healing. This means no strenuous exercise, heavy lifting, or work for at least 2 weeks.

4. What is the follow-up after urethroplasty surgery?

The follow-up is crucial as urethral strictures recur within the first year or two after surgery. At the first appointment of follow up, patients undergo cystoscopy of the urethra in the hospital. Follow up schedule is individualized depending upon the findings of these exams.

5. What to expect after urethroplasty?

Most patients recover quickly after the operation, but the swelling yielded by the procedure may take weeks to resolve. In general, it is advised to limit activity to necessities until the catheter is removed.

Citations:

https://www.centerforreconstructiveurology.org/urethral-stricture/urethroplasty/
https://www.ahn.org/services/mens-health/treatments/urethroplasty-procedures
https://www.columbiadoctors.org/specialties/urology/treatments/urethroplasty
https://www.columbiadoctors.org/specialties/urology/treatments/urethroplasty
https://www.urologyhealth.org/urology-a-z/u/urethral-stricture-disease