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.
Q. 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.
Q. 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 anything for at least 10 - 12 hours before the Urethroplasty.
Q. 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.
Recovery
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.
Result
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.
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