Urethroplasty:

Urethroplasty is a open surgical procedure for urethral reconstruction to treat urethral stricture. Urethroplasty can be performed by 2 methods; primary repair which involves complete excision of the narrowed part of the urethra. The proximal and distal patent parts are then rejoined. The second method of Urethroplasty utilizes tissue transfer or free graft technique. In this method, tissue is grafted from bladder epithelium, or buccal mucosa and is used to enlarge the strictured (narrowed) segment of the urethra.

Who is an ideal candidate for Urethroplasty?

If you have a urethral stricture due to any of the causes i.e. repeated episodes of urethritis, benign prostatic hyperplasia, scarring from a previous surgery, injury or trauma most commonly to the pelvic region or from pressure of a tumour, then you are an ideal candidate for Urethroplasty.

How do I prepare for Urethroplasty?

A thorough pre-operative assessment by your urologist would comprise of physical examination, urinalysis for the presence of blood and white cells, urine culture for infection and Cystoscopy to confirm the diagnosis of urethral stricture. The standard urethral imaging procedures like Retrograde Urethrogram (RUG) and Voiding Cystourethrogram (VCUG) will be performed. You will be hospitalized at least one day before the surgery. Inform your surgeon about your other health conditions and medications (including all the prescription, non-prescription medications, nutritional supplements i.e. vitamins, minerals and herbal products). Refrain from taking aspirin or Ibuprofen at least 2 weeks before Urethroplasty. Stop smoking a few weeks before Urethroplasty to prevent healing problems during recovery period. Do not eat or drink any thing for at least 10 - 12 hours before the Urethroplasty.

What does Urethroplasty procedure involve?

Urethroplasty is performed under general anesthesia. Two Urethroplasty techniques are popularly used:

• Anastomotic Technique - In this method of Urethroplasty, the narrowed part of the urethra is cut and the proximal and distal parts of the urethra are re-joined, a foley's catheter will be left in for the next 2 weeks to ensure complete healing and repair. This method of Urethroplasty is used for small urethral strictures i.e. less than 2 cm wide.
• Tissue Transfer - In this method of Urethroplasty, Skin and Tissue is Grafted from a non-hair bearing part of the body like the buccal mucosa or bladder mucosa. Free grafts like Full Thickness Skin Grafts or Split Thickness Skin Grafts can be used for this purpose. Tissue Transfer Urethroplasty can be also be carried out in 2 stages if sufficient local tissue is not available for a Skin Flap Procedure and local tissue factors are not suitable for a free graft.

What is the recovery period like following Urethroplasty?

You will be instructed to stay in bed for the next 2 days, you will be given pain killers and antibiotics for the next few days to help you deal with the pain and risk of infection. The indwelling catheter will be retained for 3 - 5 days. Avoid performing strenuous activities like lifting something heavy, playing sports or having sexual intercourse for at least 2 weeks after Urethroplasty. You will be able to perform all your routine daily activities in about 2 weeks time. You will be called in for follow up x-ray to ensure the results of Urethroplasty.

What is the outcome of Urethroplasty?

The success rate reported for Urethroplasty to treat urethral stricture is 70 - 80%. Urethroplasty has optimal results in case of small strictures (2 cm or less) as well as large strictures i.e. more than 2 cm.

Benefits of Urethroplasty

Urethroplasty relieves pain and discomfort during voiding, decrease in urine flow rate, frequent urination due to urethral stricture. Urethroplasty can also reduce your risk of getting orchitis, prostatitis or recurrent urinary tract infection. Recurrence of urethral stricture is rare after Urethroplasty.

Risks of Urethroplasty

• Recurrence of urethral stricture
• Infection - Wound infection or urinary tract infection
• Fistula
• Allergic reaction to anesthesia

Alternatives to Urethroplasty

• Urethral Dilatation - The goal of urethral dilatation is to stretch the scar tissue of the stricture without producing any additional scarring. This method may be effective in some very small strictures.
• Urethral Stents - In this technique, a short tube is placed inside the urethra that holds the strictured portion of the urethra open as it heals after surgery, thus preventing the normal scar formation of healing from causing the stricture to recur. The lining of the urethra eventually covers the stent, and it remains in place permanently.
• Internal Urethrotomy - Internal Urethrotomy, also known as Direct Vision Internal Urethrotomy (DVIU) is a surgical procedure used to treat urethral strictures (narrowing) due to scarring. Internal Urethrotomy can be categorized as Reconstructive Urology procedure where the normal anatomy and function of the urethra is restored by dilatation of the urethra.

Decision to have Urethroplasty

Several techniques are available for the treatment of urethral stricture. You will be evaluated pre-operatively to be suitable for Urethroplasty procedure. Discuss the procedure in detail with your physician to evaluate all the benefits and risks associated with Urethroplasty.

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