Urethroplasty

Urethroplasty is a type of surgery on your urethra. Your urethra is the tube that transports urine (pee) from your urinary bladder to the outside of your body. If you have a male reproductive system, the urethra also transports semen outside of your body.

Surgeons perform urethroplasty (yoo-REE-thruh-plas-tee) to repair or replace your urethra after scar tissue forms inside it. Your surgeon may cut out the scarred area of your urethra and reconnect the remaining ends. They may also take healthy tissue from another area of your body to rebuild the blocked portion of your urethra.

What is the reason for urethroplasty?

Healthcare providers may recommend a urethroplasty if you have:

• A urethral stricture: A urethral stricture causes part of your urethra to narrow. This can block the flow of pee.
• Epispadias or hypospadias repair: These are congenital urinary conditions. That means they’re present at birth. Surgeons typically repair these conditions during childhood. But blockages may later develop in rebuilt urethras.

How should I prepare for a urethroplasty?

Before a urethroplasty, you’ll meet with a healthcare provider. They’ll explain the procedure to you and ask for your consent. They’ll also review your health history and perform a physical exam. These ensure you’re healthy enough for surgery.

They’ll also typically determine the length and location of the blockage through the following tests:

• Retrograde urethrogram (RUG): This is a type of imaging test. It uses X-rays and contrast fluids that a provider inserts into your urethra. It helps them identify scarred and healthy areas.
• Cystoscopy: A provider inserts a small, flexible tool with a light and camera at the end (cystoscope) into your urethra. They use it to look directly at the scar.

Both tests are very quick. Your provider can usually do them in their office. The tests can cause some burning in your urethra afterward. This usually goes away quickly.

Tell your provider about any prescription or over-the-counter (OTC) medications you take. This includes herbal supplements. Aspirin, blood thinners (anticoagulants) and certain herbal supplements can increase your risk of bleeding. Check with a provider before you stop taking any medications.

You should also tell your provider about any allergies you have. These may include:

• Medications
• Skin cleaners like iodine or isopropyl alcohol
• Latex
• Foods

A provider will also give you specific directions on what and when you can eat or drink before surgery.

A provider may suggest placing a suprapubic catheter before the procedure. A suprapubic catheter allows you to drain your urinary bladder. It accesses your bladder through a small cut (incision) in your abdomen. A suprapubic catheter also allows your urethra time to “rest.” Your scar tissue can then become more obvious before surgery. Providers usually recommend one if you must use a catheter to keep the blockage open.

What healthcare providers make up a urethroplasty team?

A urethroplasty team typically includes:

• Urologist
• Anesthesiologist
• Nurses

The urologist is the surgeon who performs the urethroplasty. The anesthesiologist will give you general anesthesia. You won’t be awake or feel any pain during the procedure. Nurses assist during the procedure.

What happens during a urethroplasty?

The urologist will cut into your muscle tissue to reach your urethra. The incision may be:

• In the space between the genitals and anus (perineum)
• The underside of the penis
• In the scrotum

The urologist will then either remove the blockage or rebuild the blocked section. It depends on the length and location of the blockage.

If the blockage is longer, or if you have a penis, they’ll use tissue from another area of your body to rebuild your urethra. They usually use tissue from your cheek.

After fixing the blockage, they’ll use dissolvable stitches (sutures) to close the incision. They may also place a surgical drain. They’ll place a urinary catheter, as well. This allows pee to comfortably leave your body while your urethra heals.

What body tissues are used to fix a urethra during a urethroplasty?

Other body tissues that surgeons commonly use to fix a urethra come from your:

• Mouth: They may use the lining of your cheek or the back of your lips (buccal mucosa).
• Genitals: If you have a penis, a surgeon may use skin from there.
• Rectum: They may remove rectal tissue through your anus while you’re asleep for surgery.

How long does a urethroplasty take?

It depends on the size of your blockage. But most of the time, a urethroplasty takes three to six hours to complete.

What happens after a urethroplasty?

After a urethroplasty, you’ll spend some time in a recovery room as the anesthesia wears off. Healthcare providers will do the following:

• Monitor your overall health.
• Treat your pain.
• Give you recovery instructions. This may include how to care for your urinary catheter and how to take medications like antibiotics or those that prevent painful bladder spasms or erections.

Most people go home the same day or spend one night at the hospital. You must have someone drive you home after a urethroplasty.

About two to three weeks after surgery, you’ll have a follow-up appointment with your urologist. During this appointment, your urologist may recommend a voiding cystourethrogram (VCUG). A VCUG allows them to see how well you’re healing and how pee travels through your urethra.

How do you pee after a urethroplasty?

As your body heals, you’ll use a urinary catheter to pee. About three to four weeks after surgery, your provider removes your urinary catheter. You’ll pee through your urethra.

What are the benefits of a urethroplasty?

Research indicates that urethroplasty is the best way to treat urethral strictures so pee can flow freely. The success rate for complex repairs is around 80%. The success rate for simple repairs is between 85% and 90%.

Is urethroplasty a permanent cure?

It depends. In many cases, a urethroplasty can permanently treat a urethral stricture. But there are risks, including the need for additional procedures.

What are the risks or complications of a urethroplasty?

The main risk or complication is that a urethroplasty may not work over the long term. You may need additional procedures. These may include an internal cutting procedure to take out scar tissue (internal urethrotomy). Attend all follow-up appointments. This helps your providers keep an eye on any potential problems.

Other urethroplasty risks include:

• Anesthesia risks, including muscle pain, chills, feeling very tired (fatigue), headache and nausea/vomiting
• Bacterial infections
• Catheter leakage or blockage
• Nerve injury to your legs, feet, elbows or fingers due to the position you’re in during surgery
• Pain in your scrotum or perineum due to nerve damage
• Urinary incontinence or semen leakage
• Erectile dysfunction

Cases of nerve damage can get better over time. Erectile dysfunction is usually temporary, often going away within 18 months or fewer.

How painful is a urethroplasty?

Most people have mild to moderate pain after a urethroplasty. You may have discomfort or pain in the area for up to a week after the procedure. You can help relieve discomfort or pain with ice, prescription medications or nonsteroidal anti-inflammatory drugs (NSAIDs). Not everyone can take NSAIDs, so it’s a good idea to check with a healthcare provider before you take any.

How long does it take to recover from urethroplasty?

In most cases, it takes about six weeks to make a full recovery.

You should avoid driving and sitting for long periods while your urinary catheter is in place. You should also avoid squatting or spreading your legs far apart (like climbing high steps). Walking and climbing regular stairs are OK.

After a healthcare provider removes your urinary catheter, you should avoid sexual activity for at least six weeks. This includes masturbation.

Your mouth should heal quickly if a provider uses buccal mucosa to rebuild your urethra. New tissue should cover the area in about three weeks. A provider may prescribe a special mouthwash to keep your mouth clean and promote healing.

Is urethroplasty a major surgery?

It depends on the complexity of the procedure. For example, a repair that joins two ends of your urethra together takes less time than a repair that requires tissue from another area of your body. Tissue usually comes from the inside of your cheek (buccal mucosal graft). If a urethroplasty involves your entire urethra, the procedure may require multiple pieces of tissue from other areas of your body to rebuild your urethra. Many people can go home the same day as the procedure. But in some cases, you may need to stay overnight.

When can I go back to work or school?

It depends. For simpler surgeries, you should plan to be out of school or work for about two weeks. For more complex surgeries, you may need to take three or more weeks off. Even after you go back to school or work, you may need to limit certain activities. In these cases, your provider will give you specific instructions.

When should I call a healthcare provider?

Talk to a healthcare provider if:

• You’re having trouble peeing
• You get a lot of urinary tract infections (UTIs)
• Another provider notes you have a blockage in your urethra

After a urethroplasty, contact a provider if:

1. You have signs of an infection, including discoloration (red, purple, black or brown) in the surgical area or a fever
2. Your incision opens
3. You see a lot of blood in your underwear
4. You see drainage that looks like pus
5. You’re in a lot of unexpected pain
6. A blockage develops in your catheter
7. You get a lot of painful erections while the catheter is in place

If you have any other symptoms that concern you, reach out to a provider. They can let you know what to do next.