What Is Urethroplasty?
Urethroplasty is a surgical procedure used to repair or reconstruct the urethra, the tube that carries urine out of the body. It is often done to treat a condition called urethral stricture, which is a narrowing of the urethra that makes urination difficult.
During the surgery, the narrowed or blocked part of the urethra is either removed or widened, allowing urine to flow normally again. In some cases, tissue from another part of the body may be used to rebuild the damaged area.
This urethroplasty surgery helps improve urinary flow, reduces discomfort, and prevents repeated infections or other complications caused by a blocked urethra. It also improves overall quality of life and urinary health.
Types of Urethroplasty
Types include total thyroidectomy, partial (subtotal) thyroidectomy, and lobectomy, depending on the condition and extent of removal.
Excision and Primary Anastomosis (EPA) Urethroplasty
This is one of the most common types of urethroplasty, used for short strictures (usually less than 2 cm). In this procedure, the surgeon removes the narrowed or scarred portion of the urethra completely and then directly reconnects the two healthy ends. It is highly effective, offers a strong long-term cure, and is considered the gold standard for short strictures.
Substitution Urethroplasty with Grafts
When the stricture is longer and cannot be managed by simply removing the damaged section, substitution urethroplasty is performed. Here, the surgeon reconstructs the affected portion of the urethra using a graft most commonly taken from the inside of the cheek (buccal mucosa). This graft is carefully placed to widen and rebuild the narrowed urethra, allowing smooth urine passage. It is especially useful in complex or recurrent cases.
Flap Urethroplasty
In certain situations where grafts may not be suitable, tissue flaps are used. Instead of harvesting tissue from a distant site, a flap is created from nearby skin or tissue and rotated into place to reconstruct the urethra. This method is less commonly used today but is still effective in selected cases.
Staged Urethroplasty
For very severe, complex, or recurrent strictures, urethroplasty may need to be done in stages rather than a single surgery. In the first stage, the scarred urethra is opened and partially reconstructed, often using grafts. After healing, a second surgery is performed to complete the repair and restore a normal urinary passage. Though longer, this approach can achieve good results in difficult cases.
Perineal Urethrostomy
In rare, complicated situations where reconstruction is not feasible, a perineal urethrostomy may be done. Here, a new opening for urine passage is created in the perineum (area between the scrotum and anus). This option is usually reserved for patients with multiple failed repairs or extensive urethral damage, and while it changes the natural pathway of urination, it effectively relieves obstruction and protects kidney health.
3-6 Hours
Surgery Duration
General Anesthesia
Anesthesia Used
3-6 Months
Full Recovery Timeline
When is Urethroplasty Recommended?
Urethroplasty can be a life-changing procedure when urethral strictures or damage affect your ability to urinate comfortably and safely. Urethroplasty can be an important surgery when certain conditions affect urinary function and overall comfort. Based on clinical insights, here are the main reasons why patients may need this surgery:
- Urethral Strictures (Narrowing of the Urethra): Scar tissue, which narrows the urethra, causing weak urine flow, straining or frequent infections, is the most common cause of urethroplasty. Urethroplasty is more permanent when the less invasive measures, such as dilatation or urethrotomy, have failed.
- Traumatic Urethral Injury: The damage to the urethra can occur as a result of accidents, pelvic fractures or direct trauma. This can eventually result in strictures or blockages which are surgically repaired to bring normal urine flow.
- Recurrent Strictures After Previous Treatments: Some men undergo multiple dilatations or internal urethrotomies but continue to have strictures. In such cases, urethroplasty is recommended as the gold-standard procedure to provide long-term relief.
- Strictures Caused by Catheters, Surgery, or Radiation: Scarring of the urethra may be due to repeated catheter insertion, previous pelvic surgeries or radiation to other conditions such as prostate cancer. Urethroplasty is used to rebuild the passage and avoid complications.
- Severe Complications from Strictures: Untreated strictures can result in bladder stones, recurrent urinary tract infections, or kidney damage. Urethroplasty is advised not only for symptom relief but also to safeguard long-term urinary and kidney health.
Preparing for Urethroplasty Surgery Procedure
Preparing well before your urethroplasty surgery is important for a safe procedure and a smooth recovery.
Medical Evaluation & Pre-Op Visit
- Share your complete medical history, current medications, and any ongoing health issues with your doctor.
- Routine tests such as blood work, urine analysis, and imaging studies may be required to plan the surgery.
- Ensure test results are available at least a week before the operation to finalise scheduling and address concerns.
Health Habits & Lifestyle Adjustments
- Stop smoking at least 4-6 weeks before surgery, as it slows down healing and increases risks.
- Avoid alcohol and medicines that may increase bleeding, like aspirin, NSAIDs, vitamin E, and certain herbal supplements, for at least 2 weeks.
- Maintain a balanced diet rich in proteins, vitamins, and minerals to support faster recovery.
Prepare Your Home and Support System
- Arrange for someone to drive you to and from the hospital and assist you during the first few days.
- Keep essentials such as water, medications, loose clothing, and sanitary supplies easily accessible.
- Prepare simple meals in advance so you don't have to worry about cooking during recovery.
The Day Before & Day of Surgery
- Follow your doctor's fasting instructions, usually avoiding food and drinks after midnight before surgery.
- Take a bath as instructed, often with antiseptic soap, and avoid lotions, perfumes, or nail polish.
- Wear comfortable, front-opening clothes and remove jewellery before heading to the hospital.
What Happens During Urethroplasty Surgery?
Urethroplasty is a surgical procedure performed to repair or reconstruct the urethra when it becomes narrowed or blocked. The surgery restores normal urine flow and helps prevent repeated infections or complications.
- Preparation & Anesthesia: On the day of surgery, you'll meet your medical team to review the plan once again. In the operating room, general anesthesia is given, ensuring you remain asleep and pain-free during the procedure.
- Incision & Access to the Urethra: The surgeon makes a precise incision near the urethral stricture. This provides access to the narrowed or blocked section of the urethra.
- Repair or Reconstruction: Depending on the type of stricture, the surgeon may remove the narrowed part and join the healthy ends together (anastomosis). In other cases, tissue grafts from the cheek or skin are used to rebuild and widen the urethra.
- Catheter Placement: A soft tube called a catheter is inserted into the urethra to keep it open and allow urine to drain while the surgical site heals. This tube usually stays in place for a few weeks.
- Closing the Incisions: The incision is closed carefully with sutures, and dressings are applied to protect the surgical area.
- Recovery & Monitoring: After surgery, you'll be moved to a recovery room, where your vitals are monitored. Pain relief and antibiotics may be given, and your doctor will guide you on movement, hygiene, and follow-up care during healing.
Who will do the Urethroplasty Procedure?
Urethroplasty is typically performed by a urologist, a doctor specialized in the urinary system and male reproductive organs. In some cases, a reconstructive urologist specialising in repairing complex urethral strictures may be required.
Hospitals performing urethroplasty often provide a dedicated surgical team, including anesthesiologists, nurses, and post-operative care staff, to support the patient throughout the procedure and recovery.
Recovery After Urethroplasty Surgery Procedure
Recovering from urethroplasty is a gradual process, and proper care is essential for good healing.
First Few Days After Surgery
- In the first few days, you may feel soreness, swelling, or mild discomfort around the surgical site.
- A catheter will remain in place to allow urine to drain and protect the repaired urethra.
- Rest is important, but gentle walking helps improve circulation and prevents complications.
Doctor's Tip: "Take care of the catheter as advised and keep the area clean to reduce the risk of infection."
Weeks 2 to 4
- During this stage, you'll still have the catheter in place, but pain and swelling should slowly improve.
- Your doctor may schedule a follow-up test to check healing before removing the catheter.
- Light activities can be resumed, but avoid lifting heavy objects or straining.
Doctor's Tip: "Do not attempt to remove or adjust the catheter on your own. Always wait for your doctor's clearance."
Weeks 5 to 6
- By now, the catheter is usually removed, and you may start urinating normally again.
- Urine flow should feel stronger, and daily activities can gradually increase.
- Continue avoiding strenuous exercise or heavy lifting until advised otherwise.
Doctor's Tip: "Even if you feel better, give your body more time to strengthen before returning to full activity."
3 to 6 Months Post-Surgery
- At this stage, most patients fully recover. The urethra has healed, urinary flow is normal, and the risk of stricture returning is greatly reduced.
- Regular follow-ups may still be needed to ensure long-term success.
- Most patients notice a significant improvement in life after urethroplasty by this point.
Doctor's Tip: "Attend all scheduled follow-up visits. Early checks help catch and manage any issues before they become serious."
Benefits of Urethroplasty Surgery
Urethroplasty offers several important benefits for people living with urethral stricture or blockage. Unlike temporary treatments, this surgery provides a long-lasting solution by directly repairing or reconstructing the urethra.
Key benefits include:
- Restored Urine Flow: Makes passing urine easier and more comfortable.
- Reduced Risk of Infections: Prevents repeated urinary tract infections caused by blockages.
- Long-Term Relief: Offers better results compared to repeated dilations or internal procedures.
- Improved Quality of Life: Less discomfort, stronger urinary stream, and freedom from constant urinary problems.
- Lower Risk of Kidney or Bladder Damage: Protects the urinary system from long-term complications due to untreated strictures.
Overall, urethroplasty improves daily comfort, health, and confidence by restoring normal urinary function.
Risks of Urethroplasty Surgery
Like any surgery, urethroplasty comes with some urethroplasty risks, although most people recover well. Knowing these risks helps you prepare better and follow your doctor's advice closely.
Possible risks include:
- Infection
- Bleeding
- Stricture Recurrence
- Urinary Problems
- Fistula Formation
- Scarring or Discomfort
What is the Cost of Urethroplasty?
The Cost of Urethroplasty Surgery typically varies depending on the type of procedure, the complexity of the condition, the surgeon's expertise, and the hospital facilities. On average, urethroplasty surgery can range from Rs. 25,000 to over Rs. 1,20,000 in India.
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