Urethral Cancer: Surgery

 Surgery is the most common treatment for urethral cancer. Small, superficial tumors may be fully removed using one of many techniques. These can include the following:

• Laser resection. This is removal or destruction of the tumor using a laser.

• Transurethral resection. This is removal of the tumor with surgical instruments passed into the urethra. 

• Fulguration. This uses electrocautery (a controlled electric current) to burn the cancerous tumor away.

• Mohs surgery. This is removal of tissue in very thin layers. This is done to spare normal tissue.

Tumors that are large or invade other structures or tissues require more extensive surgery. This may be done through a cut (incision) in your skin. In men, a part of, or the entire penis, may be removed. This is called a partial or total penectomy. Your bladder, prostate gland, and lymph nodes may also be removed. In women, the urethra, bladder, vagina, and lymph nodes in the area may be removed. You may need plastic surgery to rebuild your penis or vagina.

Side effects of surgery for urethral cancer

If your bladder or your urethra is removed, your surgeon will make or build a urostomy. This is a small opening in your abdomen that gives you a new way of passing urine out of your body. You’ll then either need to wear a small pouch under your clothes to collect the urine. Or you’ll need to use a soft tube called a catheter to drain the urine from the urostomy. Having a urostomy can impact your comfort and sexuality. Ask your surgeon what to expect. Also, ask for advice in dealing with any changes that will be made. An enterostomal therapist will work with you on how to take care of the urostomy.

Risks of urethral cancer surgery 

All surgery has risks. The risks of urethral cancer surgery include the following:

• Excess bleeding

• Infection

• Blood clots

• Damage to your internal organs

• Bulging of organs under the incision (incision hernia)

• Scarring of the urethra. This may cause trouble urinating. If this happens, you may need a procedure called urethral dilation. This can help reopen the urethra.

Your surgeon will talk about your risks before the surgery. Your risks depend on your overall health, what type of surgery you need, and other factors. Talk with your healthcare provider about which risks apply most to you.

Getting ready for your surgery

 Your healthcare team will talk about the surgery options that are best for you. You may want to bring a family member or close friend with you to checkups. Write down questions you want to ask about your surgery. Make sure to ask about:

• What type of surgery will be done

• What will be done during the surgery

• The risks and side effects of the surgery

• How you’ll pass urine after surgery

• Whether the surgery will affect your ability to have sex

• When you can return to your normal activities

• If the surgery will leave scars and what they’ll look like

• Whether you’ll need more treatment after surgery

Before surgery, tell your healthcare team if you’re taking any medicines. This includes over-the-counter medicines, vitamins, and other supplements. This is to make sure you’re not taking medicines that could affect the surgery. After you’ve discussed all the details with the surgeon, you’ll sign a consent form that says that your healthcare provider can do the surgery.

You’ll also meet the anesthesiologist. You can ask questions about the anesthesia and how it will affect you. Just before your surgery, an anesthesiologist or a nurse anesthetist will give you the anesthesia. This is done so that you fall asleep and don’t feel pain.

After surgery

You may have to stay in the hospital for a few days, depending on the type of surgery you had. For the first few days after surgery, you’re likely to have pain. Your pain can be controlled with medicine. Talk with your healthcare provider about your options for pain relief. Some people don’t want to take pain medicine, but doing so can help your healing. If you don’t control pain well, for instance, you may not want to cough or turn over often. You need to do this as you heal from surgery.

You may have a urinary catheter for a few days. This is a tube put through your urethra and into your bladder so that your urine goes into a bag outside your body. In some cases, you may go home with the catheter still in. If the surgery included making a urostomy, you’ll have a bag in place on your abdomen when you wake up. Your healthcare provider will teach you how to manage it.

You may have diarrhea. Talk with your healthcare provider, nurse, or a dietitian about what you can eat to reduce the chance of getting diarrhea. You may have constipation from using some pain medicine, from not moving much, or from not eating much. Talk with your healthcare team about getting more fiber or using a stool softener.

You may feel tired or weak for a while. The amount of time it takes to heal from surgery is different for each person.

Recovering at home

When you get home, you may get back to light activity. But you should avoid heavy activity for 6 weeks. Your healthcare team will tell you what kinds of activities are safe for you while you heal.

If you have a catheter or a urostomy, your healthcare team will teach you how to manage it before you go home. If you have a urostomy, you may also be given supplies or set up to get home care visits until you’re comfortable working with the urostomy on your own.

Follow-up care

You may need radiation or chemotherapy after surgery to kill any cancer cells that may be left. This may help decrease the chance that your cancer will come back. Your healthcare provider will talk with you about these types of treatment and what you will need to do next. You’ll also see your surgeon again.

When to call your healthcare provider

Let your healthcare provider know right away if you have any of these problems after surgery:

• Bleeding

• Redness, swelling, or fluid leaking from your incision

• Fever

• Chills

• Problems with the catheter or urostomy

Make sure you know how to get help any time, even at night and on weekends or holidays.