Urethral Surgery (Urethroplasty)
What is a urethroplasty?
Urethroplasty is a surgery where the urethra is reconstructed to cure problems like urethral strictures [link to this section]. The types of surgeries are varied and depend upon the location, cause, and length of the stricture. Most surgeries take between 3-6 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 fluid and the catheter is gently removed. While X-rays are being taken, the patient urinates 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 urinate 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 every 3 months in their first year after surgery. At the first appointment patients have x-rays (retrograde urethrogram and voiding cystourethrogram [links for definitions? If not, delete) performed in the radiology department and the urinary flow rate and residual urine is measured in our office. During the next 2 appointments, at 6 and 9 months after surgery, the urinary flow rate and residual urine is measured and 1 year after surgery a cystoscopy (“look inside bladder”) is performed in the office. In this procedure a flexible small scope is placed into the urethra from the penis, very similar to catheterization and the area of the surgery is examined for recurrent strictures.
How long will recovery take?
Recovery time depends a lot on the type of surgery that was performed. Typical patients will be in the hospital 1-2 days after surgery. 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 discreet and very manageable.
What happens if 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 by cutting the stricture with a scope procedure (i.e. no incisions). This is different from 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.