Urethroplasty

Urethral reconstructive surgery, or urethroplasty, is the only "definitive" treatment option for urethral strictures.  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 and performs urethroplasty in addition to the other options above.  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.