Urethroplasty

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.

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.

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%.

What are the risks or complications of urethroplasty?

Every procedure carries risks, with problems with anesthesia and possible infections common to any surgery.

You might see issues with catheter leakage or blockage. You’ll need to see a professional to adjust your catheter. Additionally, you may get an infection in your urine or the wound, typically during or right after your catheter is in place.

The main risk or complication is that urethroplasty may not work over the long term and you might need additional procedures, such as an internal cutting procedure to take out scar tissue. This is one reason you should make sure you go to your follow-up appointments.

Other rare risks include:

• Nerve injury to legs, feet, elbows or fingers due to the position you’re in for surgery.
• Pain in the scrotum or perineum (area between the scrotum and the anus) due to nerve damage.
• Urine or semen leakage or oozing out of your penis, from collecting in the area of surgery.
• Erectile dysfunction. This is most often temporary if it occurs, resolving within 18 months or fewer.

Cases of nerve damage can get better over time.

What is the recovery time after urethroplasty?

You should avoid driving and sitting for prolonged periods while your catheter is in place. You should also avoid squatting or spreading your legs apart (as with high steps). Regular stair climbing and walking are totally fine. After your catheter is removed, you should refrain from intercourse or masturbation for a total of six weeks from the time of surgery.

Your mouth will heal very quickly. You should have new tissue covering the place where the tissue was taken in about three weeks.

When can I go back to work after urethroplasty?

Plan to be off work or school during the time that you have your catheter in. This could be two weeks for simpler surgeries, to three weeks for more complicated surgeries.

When should I see my healthcare provider regarding urethroplasty?

If you’re having trouble urinating or have many urinary tract infections, or if you’ve been told you have a blockage of your urethra, you should contact your healthcare provider.

If you’ve had urethroplasty, you should follow your surgeon’s instructions on when you should contact a healthcare professional, including if:

• You have a fever.
• Your incision has opened.
• You see a lot of blood on your underwear.
• You see drainage that looks like pus.
• You’re in a lot of unexpected pain.
• Your catheter is blocked.

If you have symptoms that concern you, contact your healthcare provider. They’re in the best position to let you know what you should do next.

A note from Cleveland Clinic

Urethroplasty is a type of surgery to repair your urethra, the internal tube that transports urine out of your body. You may need urethroplasty because of scarring in your urethra that makes it difficult for your urine to flow freely. Surgery may also be part of a series of gender affirmation surgeries. The outlook for someone who has urethroplasty is generally quite good, but talk with your healthcare provider about any concerns or worries.