What is Urethral Surgery – 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 3–6 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 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 is healed, then the catheter is left out and patients begin to void normally.
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 overnight 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 unobtrusive and very manageable.
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 3–6 months in their first year after surgery. At the first appointment patients undergo cystoscopy of the urethra in the office and the urinary flow rate and residual urine is measured in our office. Cytoscopy is a scope exam of the urethra where a 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. Follow up schedule is individualized depending upon the findings of these exams.
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 that often has too much scarring to respond long-term to an internal cutting procedure. Some strictures are too dense and do not respond to internal cutting and further surgery is indicated.
What is the success after urethroplasty?
Different surgeries have different success rates. Generally, strictures can be resolved in 75–85% of cases. If strictures come back, only about one half cause symptoms. In other words if a stricture comes back, it has to be very tight to cause blockage of urinary flow, just like the original stricture. If patients have symptoms, then an internal cutting surgery with a scope is usually tried (direct vision internal urethrotomy). If this doesn’t work, then patients may need additional surgery, which is a rare circumstance.