Urethral Surgery (Urethroplasty)
What is a urethroplasty?
Urethroplasty is a surgery where the urethra is reconstructed to cure problems like urethral strictures. The types of surgeries are varied and depend upon the location, cause, and length of the stricture. Most surgeries take between 3-5 hours to complete. An incision is made over the area of the stricture in the penis, scrotum or perineum (the area between the scrotum and the anus). After surgery, a urethral catheter is left in for 2-4 weeks depending upon the type of surgery that was performed. When patients return to clinic the bladder is filled with X-ray contrast and the catheter is gently removed. While X-rays are being taken, the patient voids and the area of the surgery is evaluated. If the area of surgery shows no leakage, the catheter is left out and patients begin to void normally.
What is the follow up after surgery?
The follow up after urethroplasty is very important; this is because most urethral strictures recur within the first year or two after surgery. Patients are seen at 3 months after their surgery. At this appointment patients have their urinary flow checked and also undergo a gently cystoscopy. In this procedure a scope the size of a small catheter is passed up to level of the urethropalsty surgery and the area is examined for re-scarring. We emphasize that this procedure is very atraumatic and we do not dilate the area or pass the scope through the urinary sphincters (typically the portion of a cystoscopy the causes pain). Patients return again at 12 months for the same exam and then yearly afterward. If patients have symptoms of stricture recurrence like urinary infection, blood in the urine or a slow stream we will do a thorough evaluation to determine the cause of the symptoms and to make sure the surgery has not failed.
Cystoscopic exam of the area of a urethroplasty showing very good healing at the connection of the urethra after removing scar tissue
How long will recovery take?
Recovery time depends a lot on the type of surgery that was performed. Typical patients will be kept overnight in the hospital and are ready to leave the next day. As soon as they can eat, walk and care for their catheter they can leave the hospital. It is important to limit activities after urethroplasty until adequate healing has occurred. This means no heavy lifting, strenuous exercise or work for at least 2 weeks. Generally, it is best if patients do not work while the catheter is in place, however, patients can start doing work that is not physical after 10-14 days. The catheter can be worn draining to a smaller bag that straps to the lower leg under a pair of pants. Wearing a catheter like this is unobtrusive and very manageable.
What happens when strictures come back after surgery?
When strictures come back after surgery they often are thin and web-like. These strictures can cause a lot of obstruction but often can be treated internally by cutting the stricture with a scope procedure. This is dissimilar to the initial stricture which often has too much scarring to respond long-term to an internal cutting procedure. Uncommonly, some strictures are too dense and do not respond to internal cutting and further surgery is indicated.