Urethroplasty: Procedure, Cost, & More

What are the Symptoms And Complications Of Urethral Strictures?

Patients with urethral strictures or a narrowed/blocked urethra experience the following symptoms:

• A weak/fine urinary stream
• Spraying/forking of the stream
• Straining to urinate
• Pain during urination
• Frequency and urgency attached to urination
• Incomplete bladder emptying
• Irritation in the urethra
• Urinary tract infection (UTI)

Complications in patients with urethral strictures include:

• Infection, which can be a urine infection or that locally in the urethra
• Periurethral abscess
• Urinary retention
• Urinary incontinence
• Urethral fistulas
• Stones in the bladder and urethra
• Rarely, squamous cell carcinoma of the urethra

Why Choose Medfin?

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty tasks of finding the best hospital, the finest doctor, and the latest procedure at the lowest costs. Let us take charge while you sit back and focus on your health & recovery. Think surgery! Think Medfin!

When To Call For Help After a Urethroplasty?

Call your doctor when you notice any of the following symptoms:

• Fever (over 101.5° F) along with sweats and shivering
• Pain in the leg
• Severe pain that does not relieve even with pain medications
• Bright red blood in the urine
• Large clots, making urination difficult
• Pus-like drainage
• Opened incision or blocked catheter

What Are The Benefits And Risks Associated With Urethroplasty?

Benefits

• Restoration of normal urine function
• Lower risk of infection or inflammation of the testicles
• Reduces chances of urethral stricture recurrence
• Improved sexual function
• Better quality of life

Risks

• Infection in the wound or urine
• Catheter blockage or leakage
• Problems with anesthesia
• Urinary incontinence
• Urinary retention
• Bleeding
• Erectile dysfunction
• Fistula
• Nerve injury
• Pain in the scrotum or perineum
• Urine or semen leakage out of the penis
• Need for additional surgery

What to Expect After a Urethroplasty?

• You are taken to the recovery room where you stay till discharge. Most people go home on the day of the procedure while some may need to stay one night in the hospital. This depends on your age, procedure length, and your medical condition.
• The doctor will prescribe pain medication, antibiotics, medication to prevent bladder spasms, and medication to stop erections before you go home. 
• You may feel an urgency to urinate for the first few days after surgery.
•  You can also expect there to be some pain/swelling in the penis or scrotum. Apart from pain medication, the doctor may recommend a jock strap or tight underwear for supporting the scrotum and limiting swelling.
• If a graft was used from the cheek’s inner side (buccal mucosal graft), there can be soreness in the mouth. The doctor may give you a special mouthwash to keep the area clean.
• There are no dietary restrictions post-urethroplasty. Patients can hence resume their regular eating habits immediately, although, those with buccal mucosal graft would prefer a soft diet.
• You will need to limit your activity levels for several weeks (at least two weeks) to allow for proper recovery. This includes avoiding driving, cooking, and drinking alcohol. 
• Sexual activities need to be avoided for six weeks. Avoid heavy lifting, squatting, or spreading legs apart and extended walking/running. 
• You may start normal physical activities such as light walking and taking stairs (not high rise).
• To facilitate healing, you can use ice packs, scrotal support, and gauze pads.
• The catheter is removed 2 to 3 weeks post-surgery. 
• You are required not to miss any scheduled follow-ups.
• The doctor will schedule an appointment 2 to 3 weeks after the surgery to check your progress. A radiologist will fill your bladder with contrast, remove the catheter and take X-rays while you pass urine. The images will then be reviewed.

How is Urethroplasty Performed?

Urethroplasty is widely performed by Medfin’s expert surgeons. Here are the steps of the procedure:

• The surgery starts with the administration of general anesthesia to put you to sleep throughout the procedure. A tube may also be inserted into your throat to help you breathe.
• You are made to lie down in a lithotomy position (lying on the back with legs separated and elevated with support).
• An intravenous (IV) line is placed in a vein in your hand or arm to provide medicines such as antibiotics.
• Urethroplasty begins with an incision either on the underside of the penis, between the scrotum and anus (perineum incision), or rarely in the lower abdomen. Occasionally, a combination of incisions may be used too.
• Now, the urethra is approached by cutting and separating the surrounding muscle tissue to remove the scar tissue.
• If the strictures are short, the two cut ends of the urethra are sewn together (anastomosed). It has to be made sure that there is no tension on the sewn edges.
• As discussed, the urethroplasty procedure may involve taking tissue from other parts of the body (graft) and using it to repair the urethral region, if the gap between the two cut ends of the urethra is quite large.
• Once the repair of the urethral edges is complete, the surgeon closes the incisions and applies a bandage.
• Finally, a catheter is placed in the urethra to allow it to heal while ensuring that urine is able to leave your body.

What Happens Before a Urethroplasty?

• Before scheduling a urethroplasty, consult a doctor to discuss the procedure in detail. speak about the benefits and risks, and resolve your expectations and any doubts you may have.
• The doctor would want to know your medical and surgical history, as well as any specific symptoms that lead you to consider urethroplasty. 
• The scar tissue in the urethra needs to be accurately located, which is done with the help of an X-ray of your urethra. A uroflow test or cystoscopy might be used to evaluate the urinary tract. The uroflow test, in particular, helps measure the flow and force of the urine.
• An X-ray test called retrograde urethrography may be used to measure the dimensions of the urethral stricture. 
• The doctor may advise that a suprapubic catheter be placed in your bladder before surgery to allow the bladder to be emptied and give the urethra some time to rest so the scar tissue is apparent prior to the surgery. 
• You need to keep your doctor well-informed of all medications or supplement pills that you take. You may be asked to discontinue any medication that may increase the risk of bleeding during the surgery. 
• You also need to focus on avoiding constipation. Eat a balanced diet comprising fiber-rich foods a week before the procedure. In case you have a history of constipation, make sure you undergo an enema the night before the day of surgery.
• You are not supposed to eat or drink after midnight on the day before the procedure.

What are the Types Of Urethroplasty?

There are several types of urethroplasty performed :

1. Anastomotic Urethroplasty or EPA (Excision and Primary Anastomosis) Urethroplasty 

In this type, an incision is made in the space between the scrotum and anus, and some segment of the bulbar urethra between the scrotum and prostate is removed. Then, the two cut ends of the urethra are sewn together. EPA is more suitable when the strictures are short, located deep in the urethra, and are closer to the prostate in the bulbar urethra.

2. Graft Urethroplasty

In this method performed for longer urethral strictures, an incision is made between the scrotum and anus. The scar tissue causing the blockage is opened up and removed.  A graft is taken, generally from the buccal lining of the oral cavity (buccal mucosal onlay graft) or in some cases, the extra-genital skin. The urethra is then repaired using a patch made from this graft piece.

3. Penile Flap Urethroplasty

This method is used when the stricture is located in the penile urethra. It involves removing the urethral stricture and repairing the narrowed or damaged portion of the urethra with a flap of the penile skin.

4. Staged Urethroplasty 

This method is used when a stricture requires more than two processes to treat. Staged or Johanson’s urethroplasty involves two stages. First, the scarred urethral tissue is removed as well as replaced with a graft. After this surgery (first stage), the artificial urethra thus created, takes a few months to heal. Now, a second surgery is performed about 3 months later, where the graft is formed into a tube for reconstructing the urethra.

Why Is Urethroplasty Performed?

There are several indications that call for urethroplasty as the suitable treatment option:

• Urethral strictures: A urethroplasty is most commonly performed for urethral strictures. As mentioned before, urethral strictures are the narrowing of your urethra due to the formation of scar tissue. They cause discomfort with urinating and a slowing of the urinary stream. Strictures are more common among men than in women since men have a longer urethra
• Epispadias/Hypospadias: These are two congenital conditions that affect the urethra during childhood. In epispadias, the urethra does not develop properly and urine exits the body from an abnormal location. In hypospadias, the opening of the urethra is on the underside of the penis instead of at the tip. If you had a repair for any of these, then there are greater chances of you developing blockages in the urethra. 
• Gender affirmation surgery: It’s a surgery that helps people transition to their self-identified gender. Complications or unsatisfactory results during this surgery can result in the need for a urethroplasty. 
• Urethroplasty may also be the right choice when less invasive treatments (such as urethral dilatation, catheters, or urethrotomy) have failed.

What Is Urethroplasty?

Urethroplasty refers to the surgery performed on the urethra to treat urethral strictures. The urethra, part of your urinary tract, is a tube that lets urine exit the bladder and travel outside the body. 

Now, urethroplasty comes into the picture when the urethra develops some scar tissue inside and becomes narrow because of the development of urethral stricture. The surgeons use urethroplasty to correct this narrowing and unblock the urethra to allow a smooth flow of urine.