Renal Transplant in Lucknow

What is a Urethroplasty?

Urethroplasty is surgery performed on your urethra, a part of your urinary system. The urethra is a tube that carries urine from your urinary bladder to the outside of your body. In men, the urethra also carries semen outside of their bodies.

Why is a urethroplasty done?

Urethroplasty is done to repair or replace your urethra when scar tissue forms inside it. Your surgeon connects two ends of your urethra after cutting out the scar tissue, or may borrow tissue elsewhere in your body to rebuild the portion of your urethra that’s blocked.

You may need urethroplasty if:

  • You have a urethral stricture. This means that some part of your urethra has become narrower, blocking the flow of urine. Urinary strictures are much more common in men than women.
  • You have epispadias or hypospadias, congenital conditions that affect your urethra, which were repaired in childhood. Blockages are especially common in urethras that have previously been rebuilt.
  • You’ve had gender affirmation surgery.

Symptoms Indicating the Need for Urethroplasty

  • Difficulty Urinating: Trouble starting or maintaining a urine stream.
  • Weak Urine Stream: A significantly reduced or interrupted urine flow.
  • Frequent Urination: Increased frequency or urgency to urinate.
  • Painful Urination: Discomfort or pain during urination.
  • Incomplete Bladder Emptying: Feeling as though the bladder is not fully emptied.
  • Urinary Retention: Inability to urinate, leading to discomfort or bladder distension.
  • Recurrent Urinary Tract Infections (UTIs): Frequent infections due to urinary flow obstruction.

Is urethroplasty considered major surgery?

The length of time surgery lasts depends on how much repair work is being done. For instance, a repair that joins two ends of your urethra together takes less time than a repair that requires tissue from another place in your body. If your entire urethra is involved, multiple pieces of tissue can be needed to rebuild the urethra. Other body tissues used most often to fix a urethra come from:

  • Your mouth, from the lining of your cheek or back of your lips. This is called the buccal mucosa.
  • Your genitals. If you have a penis, your surgeon might use skin from there. If you’re having gender affirmation surgery, your surgeon might use skin from your vagina or labia.
  • Your rectum, via a procedure done through your anus while you’re asleep for surgery.

Types of Urethroplasty

Anterior Urethroplasty:

Indication: For strictures in the penile or bulbar urethra.

Procedure: Involves removing the narrowed segment and reconstructing the urethra using a graft (typically from buccal mucosa or skin).

Posterior Urethroplasty:

Indication: For strictures in the prostatic or membranous urethra.

Procedure: More complex, often involving bladder neck reconstruction or grafting.

Strictureplasty:

Indication: For short or localized strictures.

Procedure: Widening the narrowed area without removing it, often through suturing or dilation.

Treatment and Procedure Details

What happens before a urethroplasty?

The length and location of the blockage are typically confirmed by an X-ray called a retrograde urethrogram, or cystoscopy. Both are very quick and minimally painful procedures done in your healthcare provider’s office. Before the day of the surgery, your healthcare provider will give you instructions on what and when you can eat or drink and what to do about any medications you take.

Your healthcare provider may suggest you have a suprapubic catheter placed before your surgery to allow your bladder to be emptied and your urethra time to “rest” so scar tissue can declare itself (and thus be fixed) prior to surgery. This is usually recommended if you require self-catheterization to keep the blockage open. These types of catheters are placed directly into your bladder from the pubic area (just above the pubic bone).

You’ll remove your jewelry, change into a hospital gown and then go to the operating suite. You’ll be given general anesthesia to put you into a deep sleep.

What happens during a urethroplasty?

Your surgeon will cut into your muscle tissue to reach your urethra. The incision is typically either on the underside of your penis, in your scrotum or (most commonly) between your scrotum and anus (perineum). The location of the stricture is identified and either removed, or that section is rebuilt depending on its length and location.

If the blockage is longer, or located in the penile urethra, the surgeon will harvest your mouth, genital or rectal tissue to supplement the incised (cut away) tissue from your urethra. The incision is then closed, and usually, a small drain is placed for a day or so. You’ll have a catheter to allow the urethra to heal while urine is still able to leave your body. Your muscle and skin will be closed up with stitches that are absorbed by your body — you don’t have to get them taken out.

What happens after a urethroplasty?

You’ll spend some time in the recovery room, to come out of the anesthesia. You’ll need to have someone drive you home if you’re having urethroplasty as an outpatient procedure. Most people either go home the same day or stay one night in the hospital. You’ll be sent home with a urinary catheter, pain medication, antibiotics and possibly medication to prevent bladder spasms. You might also be given medication to stop you from having erections. If tissue from your mouth is used to reconstruct your urethra, you may have a special mouth wash to keep the area clean.

After urethral reconstruction, you’ll have an appointment with your healthcare provider about two to three weeks after surgery. At that time, you might have a radiology procedure to check the area of repair if you haven’t had one before this visit. If you need the procedure, the radiologist will fill your bladder with contrast, remove the catheter and take X-rays while you urinate. You’ll then meet with your clinical team, who’ll review these images.

What are the advantages of urethroplasty?

Research indicates that urethroplasty is the best way to treat urethral strictures so urine can flow freely. The success rate is fairly high at over 80%. In some cases, depending on the location and length, the success rate is reliably higher than 90%.

Risks and Complications

Infection: Risk of urinary tract or wound infection.

Bleeding: Potential for bleeding during or after surgery.

Recurrence of Stricture: Possibility that the stricture may recur, requiring further treatment.

Urinary Incontinence: Risk of temporary or permanent urinary incontinence.

Sexual Dysfunction: Potential for erectile dysfunction or other sexual issues, particularly with posterior urethroplasty.

Pain or Discomfort: Some patients may experience persistent pain or discomfort after surgery.

Benefits of Urethroplasty

Effective Treatment: Provides a long-term solution for urethral strictures, often with significant improvement in urinary function.

Restored Function: Improves urine flow, reduces symptoms like pain and discomfort, and can resolve urinary retention.

Minimally Invasive: Compared to open surgery, urethroplasty is less invasive and can be performed with fewer complications and quicker recovery times.