Reconstruction | Male | Urethroplasty

Description of Procedure

Urethral reconstructive surgery, or urethroplasty, is the only "definitive" treatment option for urethral strictures.  It is usually reserved for strictures that are severe or non-responsive to endoscopic management.  Few Urologists perform these procedures as training in them is hard to come by.  Dr. Rapoport is one of a handful of urologists in Canada with fellowship (subspecialty) training in urethral reconstruction. 

 

There are 2 general types of urethroplasty proceudres: primary anastamotic repairs and substitution repairs.  Primary anastamotic repairs involve excision of the stricture with reconnection of the healthy ends of urethra in a widened configuration.  Substitution urethroplasty involves tissue transfer techniques typically using buccal mucosa (inner cheek lining) grafts or genital skin flaps to build on to the stricture and increase its caliber.  When possible, anastamotic repairs are preferred as they are less complex and carry excellent durable success rates (>90%).  There are certain situations, usually when the stricture is too long, where substitution techniques are required.  These too carry excellent success rates (>80%).  Certain cases require a combination of techniques, typically when there are multiple severe strictures present.

 

Although urethroplasty is associated with the best chance of “cure”, it is surgery that requires an anesthetic, incision and catheterization for 7-21 days depending on the type of repair.  Most patients will be able to return to their usual daily activities about 2 weeks after urethroplasty.

 

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After Procedure

If you have questions that are not answered here, please contact us.

What to Expect

Swelling and bruising of scrotum often progress for 24-48 hours before starting to improve.
You may experience pain or discomfort around incision sites.
Catheter should be draining.  Urine may appear discolored or bloody at times.  Please see catheter care instructions.
If a graft was removed from the inside of the mouth (buccal mucosal graft), your cheek may be swollen for 24-48 hours after surgery.

 

Cautions

Report any of the following to your doctor:

  • Redness, foul-smelling drainage or separation of incision site.
  • Fever over 38.5 C.
  • Severe pain unrelieved by medication.
  • Catheter blocks or passing large blood clots despite good hydration.
  • Catheter falls out.

 

 

Diet

Clear liquid diet immediately after surgery, then advance to usual diet as tolerated.
Try to drink 6-8 glasses of water per day.
If a graft has been taken from your mouth stay on fluids/soft diet (eg. Scrambled eggs, mashed potatoes, broth, purees) until chewing no longer causes pain at graft site – usually 2-4 days.

 

Activity

Get up and about as soon as possible after surgery. Walking and stairs are fine.
Use an ice bag on the scrotum for the first 24-48 hrs to reduce swelling.  Wrap the ice bag in a washcloth.  Do not apply ice directly to skin.  Apply 15 minutes on and 15 minutes off while awake.
Avoid lifting more than 20 lbs for one month.
Avoid pressure on your incision behind your scrotum. Use a soft pillow or horseshoe/doughnut cushion for sitting.
You may start showering 24-36 hrs after surgery.  Avoid water stream directly on incision and dry it well afterwards.  You may sponge bathe.  Do not submerge in a tub bath for 3-4 weeks.
Avoid driving while catheter is in place. 
Please review catheter care instructions.
Wear supportive underwear. You may wear an athletic support over your underpants for additional support.
If a graft has been taken from your mouth, rinse with warm salt water as needed.  Separate your cheek from your gums 2-3 times per day with your tongue or finger until all swelling has disappeared.

Medications

Take antibiotics as per prescription.
Use prescription pain medication and bladder spasm pills as needed.
Do not apply ointments or creams to incisions. 
Take a stool softener (obtain over the counter at local pharmacy) starting the night of your surgery.  Stop taking stool softeners once having soft bowel movements.  Do not take stool softeners if diarrhea occurs.
If you have not had a bowel movement by the 3rd day after your surgery, take a laxative (obtain at your local pharmacy over the counter).
You may begin your regular medications when you leave the hospital unless instructed otherwise.
If you take bloodthinners (ASA, plavix, warfarin), your doctor will advise when you can start them again.

 

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