Urethroplasty
Urethroplasty can provide relief from urethral strictures.
Urethroplasty is a surgical procedure used to correct urethral strictures and other issues via reconstructing the urethra.
How it is Done
The surgeon may begin the surgery by creating an incision over the stricture area in the scrotum, penis, or perineum. Exactly what needs to be done after making the incision depends on the exact reason the patient is undergoing urethroplasty.
Once the surgery is complete, any incisions that were made are closed, usually with stitches. A catheter is then inserted into the urethra. How long it has to remain in place depends on the procedure that is done and its overall extent.
Once the patient can have the catheter removed, they will return to their doctor. X-ray contrast is pumped into the bladder and the catheter is then gently removed. X-rays are taken at this time to evaluate the healing of the surgical area.
Recovery
The method used for this surgery will ultimately determine the recovery time. In most cases, patients spend at least one night in the hospital. Once they can walk, eat, and perform catheter care, they are usually discharged.
For at least two weeks, patients are advised to avoid strenuous activity and heavy lifting.
They may also need to stay home from work. It is advised that patients refrain from returning to work until the catheter is removed. They should wear clothing that does not obstruct the catheter. Good choices are shorts or pants that fit loose.
Follow-Up Care
Overall, the procedure has a relatively high success rate. If strictures recur, symptoms only tend to present themselves in about half of cases. While complications are not common, patients should still be aware of what they are so that they can look out for them. They may include:
- Infection
- Urinary retention
- Penile sensation loss
- Referred pain
- Urinary urgency
- Hematoma
- Internal suture line bleeding
- Urinary incontinence
- Erectile dysfunction
- Retrograde ejaculation
- Urinary fistula
- Urine spraying
- External bleeding
In most cases, the strictures come back within one to two years of having the surgery done. Because of this, doctors typically want to see their patients every three to six months during the first year that follows this procedure. The exact follow-up schedule will be determined based on how the surgery went and what is noted at the first follow-up appointment.
The first follow-up appointment generally involves patients getting a cystoscopy. This allows the doctor to better examine the urethra to see if any recurrent strictures are present. Doctors will also usually measure residual urine and urinary flow rate.
If any recurrent strictures are web-like and thin, a scope procedure may be enough to take care of them. However, if they do not respond to scope treatment or they are especially dense, further surgery might be necessary.