Urethroplasty is a surgical procedure to treat recurrent or long (over 2cm) urethral strictures.
The precise surgical approach depends on the location and length of the stricture. The surgery may involve removing the strictured segment and reconnecting the healthy ends of the urethra (excision and primary anastomosis), or it may involve placing a graft of tissue from the inner cheek for longer defects (buccal mucosal urethroplasty). Prior to proceeding with surgery, the stricture must be allowed to mature without disruption for about 10-12 weeks so that the true extent can be identified during the urethroplasty. This period of urethral rest may require a suprapubic tube placed through the lower abdomen to drain urine if the patient is unable to void through the strictured urethra.
When to Ask a Urologist about Urethroplasty
You should speak with a Urologist about Robot-Assisted Pyeloplasty if you have a urethral stricture.
Cost
Typically covered by most insurances (although coinsurance and deductibles may apply). Coverage will be verified prior to proceeding. If you do not have insurance, our office will be able to give you an out-of-pocket cost estimate.
Effectiveness
Urethroplasty can be very successful and far surpass outcomes associated with endoscopic techniques using instruments passed up the penis (around 90% vs around 20%).
Possible Side Effects
The risks associated with urethroplasty include bleeding, infection, damage to adjacent structures, peripheral nerve injury from operative positioning, penile curvature, impaired ejaculation (20% risk), erectile dysfunction (very rare), and recurrent stricture formation.
Alternative Approaches
Alternatives to urethroplasty include chronic intermittent catheterization, chronic suprapubic tube, perineal urethrostomy, and endoscopic management with urethral dilation or direct vision internal urethrotomy.
What to do to Prepare for Surgery
You will receive detailed instructions from the surgical schedulers regarding any necessary testing or appointments prior to surgery. In general, you should temporarily stop blood-thinning medications prior to surgery (when to stop depends on the type of blood thinner). Prescription blood-thinning medications should be stopped following clearance from the doctors that prescribed them though other medications that thin the blood including fish oil and pain relievers such as ibuprofen should be stopped as well.
On the day before surgery, you will receive a phone call alerting you to the time that you should arrive, and you should wash the surgical area with an antibacterial soap. You may be instructed to drink one bottle of magnesium citrate to evacuate the bowels in preparation for the procedure.
You should not eat or drink anything after midnight on the day of surgery, but you may take approved home medications in the morning before surgery with a small sip of water.
What to Expect after Surgery
The surgery typically requires overnight hospitalization. Patients have a catheter draining their bladder through their penis that will be left in position for at least 3 weeks. An additional bladder drainage tube through the lower abdomen called a suprapubic tube may also be left in position until the urethra has healed. The incision is located underneath the scrotum and above the anus.
The urine is usually tinged with blood. Light activity, including walking, under nursing supervision is recommended. The nursing staff will also provide teaching to use a breathing device called an incentive spirometer that helps encourage patients to take deep breaths. Patients may begin drinking liquids following surgery and can slowly advance to more solid food as tolerated.