Urethroplasty for Urethral Stricture
You have elected to undergo a urethroplasty for the management of your urethral stricture (scar). The primary purpose of a urethroplasty is to significantly improve your urinary symptoms. This information is aimed at helping you understand your surgery and what you can expect when you go home. Please keep this information as you may want to review it again after your surgery.
What are the different types of urethroplasty ?
A urethroplasty is the surgical repair of a urethral stricture. A one-stage repair is the most common form of repair. Depending on the length and location of the stricture, different options are available for its repair. Options for repair are: 1) excision of the stricture and reconnection of healthy urethra; 2) excision of the stricture and reconnection with a graft; and 3) graft reconstruction alone.
If a graft is needed, the best source for a graft is the lining on the inside of the cheek (buccal mucosa).
Some strictures (fewer than 10%) may require staged repairs (multiple operations over a year-long period) due to their length or other complexities. These include long strictures, particularly those caused by balanitis xerotica obliterans (BXO).
What are the results?
Cure rates are usually better than 90%; however, rates decrease with more complex repairs (i.e. staged repairs).
What are the risks?
All surgeries carry some risk. There are customary risks of anesthesia and surgery, such as bleeding, infection, injury to adjacent organs and their function, and chronic pain. Specific risks for urethral surgery are possible changes in sexual function. Although uncommon, poor erections, minor penile shortening, penile curvature and changes in ejaculation may occur. Bladder control is rarely affected.
You will come back to clinic before your surgery date for your pre-op visit. We will discuss your surgery, answer any questions you have and sign the operative consent form.
It is very important that you do not have a urinary tract infection at the time of surgery. We will check a urine culture at your pre-operative visit. Please ensure that before you have left the clinics on your pre-op day that you have given a urine specimen.
After meeting with us in the urology clinic, you will then go to your pre-op anesthesia appointment and get any necessary pre-operative blood work. If you are under the care of a cardiologist, please bring any records on your cardiac work-up with you to this visit. Please bring your medications or an accurate list of your medications with you to this visit. The anesthesia team will tell you which medications to take before the surgery. We will also let you know when to restart these medications after surgery.
If you live far away, you may want to arrive the day before surgery. If you are planning to do this, please be sure that we have an alternative number (i.e. cell phone) where we can reach you to be sure you know what time to arrive for surgery.
We also recommend that you remain in the area the night after surgery. Some patients (those with a urethral stricture due to a pelvic fracture or those in whom a staged repair is planned) may be required to spend the night in hospital. We will let you know if you will need to stay in the hospital after surgery.
The night before surgery
You cannot eat or drink anything after midnight on the night prior to your surgery. Take your morning medications unless otherwise directed.
The day of surgery
A family member/friend must accompany you to the surgery, stay the entire time while you are in surgery and be able to drive you home afterwards. You will not be able to drive yourself home.
A urethroplasty is performed with an incision under the urethra (the location of the incision depends on the location of the stricture). The surgery takes approximately 2 hours and can be done under spinal or general anesthesia (general anesthesia is needed if a graft is needed). All the stitches will dissolve on their own. We use skin glue to reinforce the incision. Please do not pick this off as it will dissolve on its own.
You will have a catheter after the surgery for 2 to 3 weeks in order to allow the urethral to heal. If you already have a suprapubic tube, we will usually leave this in until the urethral has healed.
The recovery room
After surgery, you will go to the recovery room. You will be instructed on how to care for the catheter before you are discharged from the recovery room/hospital.
You will be provided with a horseshoe pillow. We recommend using that when sitting on hard surfaces. Once the recovery room team feels you are ready, you will be discharged from the hospital. You will also receive additional post-operative instructions before you leave the recovery room/hospital.
It is important that you get up and walk around as soon as possible after surgery. You need to avoid lifting anything over 20 pounds for 4 weeks following surgery. We recommend avoiding strenuous activities. We also ask that you avoid activities that put pressure on the incision in between your legs (i.e. bikes, riding mowers, etc).
You should plan to be out of work for at least 1 to 2 weeks following surgery. Your ability to return to work after surgery depends on your work requirements. It is important that you follow the activity restrictions as mentioned above for 3 to 4 weeks following surgery.
You should not drive while you are taking pain medications. We recommend not driving for 7 days following surgery. You cannot drive if you are still taking narcotic pain medication or have limited mobility.
We will see you back in the urology clinic 2 to 3 weeks after the surgery.
You will have an X-ray (a retrograde urethrogram) at your follow-up visit prior to seeing the doctor and/or his staff to ensure that the urethra has healed. Once we review the X-ray and have examined you, we will remove the foley catheter. You should remain in the clinic area until you are able to urinate.