Urethroplasty

Urethroplasty is surgery to treat a narrowing (stricture) of the urethra. In men, the urethra carries urine from the bladder out of the body through the penis. It also carries sperm from the testicles, seminal vesicles, and prostate gland through the penis. The urethra may have a stricture that blocks the normal flow of urine. As a result, urine can back up in the kidneys and the tubes (called ureters) that carry urine from the kidneys to the bladder. This can lead to infection and kidney damage. Urethroplasty may be used to treat a stricture if less invasive treatments don’t work or are not right for you.

Preparing for surgery

Prepare for the surgery as you’ve been told. In addition:

• Tell your doctor about all medicines you take. This includes prescription medicines and over-the-counter medicines, vitamins, herbs, and other supplements. It also includes any blood thinners, such as warfarin, clopidogrel, or daily aspirin. You may need to stop taking some or all of them before surgery.

• Follow any directions you are given for not eating or drinking before surgery. This includes coffee, water, gum, and mints. (If you have been instructed to take medicines, take them with a small sip of water.)

The day of surgery

The surgery takes about 3 to 6 hours. Afterward, you will stay in the hospital for 1 to 3 nights.

Before the surgery begins:

• An IV (intravenous) line is placed in a vein in your arm or hand. This supplies fluids and medicine (such as antibiotics).

• You may be given a medicine to prevent blood clots.

• To keep you pain-free during the surgery, you’re given general anesthesia. This medicine puts you in a deep sleeplike state through the surgery. A tube may be inserted into your throat to help you breathe.

During the surgery:

• Incisions are made near the area that needs to be repaired. This may be in the skin between the scrotum and anus. This may also be on the penis.

• The method used to repair the stricture is chosen based on the location and length of the stricture.

• First, the stricture is cut out. The remaining ends of the urethra may then be sewn together. Or the urethra may be repaired with skin and tissue taken from another part of the body, such as the inside of your mouth.

• In some cases, more than one surgery may be needed to repair the urethra. This is called a two-stage repair. Your doctor can tell you more.

• When the surgery is complete, the skin incisions are closed with stitches.

• A thin tube (Foley catheter) is placed into your bladder. Another thin tube (suprapubic catheter) may be placed through a small incision in your belly (abdomen), into your bladder. These tubes help drain urine until healing is complete.

Recovering in the hospital 

After the surgery, you will be taken to a recovery room. Here, you’ll wake up from the anesthesia. You may feel sleepy and nauseated. If a breathing tube was used, your throat may be sore at first. When you are ready, you will be taken to your hospital room. While in the hospital:

• You will be given medicine to manage pain. Let your providers know if your pain is not controlled.

• As soon as you’re able, you’ll get up and walk.

• You’ll be taught coughing and breathing techniques to help keep your lungs clear and prevent pneumonia.

Recovering at home

After your hospital stay, you will be released to an adult family member or friend. Have someone stay with you for the next few days, to help care for you. Recovery time varies for each person. Your doctor will tell you when you can return to your normal routine. Until then, follow the instructions you have been given. Make sure to:

• Take all medicines as directed.

• Care for your incisions as instructed.

• Care for your catheters as instructed. Make sure nothing pulls on the catheters (such as clothing).

• Follow your doctor’s guidelines for showering. Don't swim, take a bath, use a hot tub, or do other activities that cause the incision to be covered with water until the doctor says it’s OK.

• Not do any heavy lifting and strenuous activities, as directed.

• Not have sex for 4 to 6 weeks.

• Not drive until your doctor says it’s OK. Don’t drive if you’re taking medicine that make you drowsy or sleepy.

• Wear a jockstrap for support as directed.

• Walk a few times daily. As you feel able, slowly increase your pace and distance.

• Not strain to pass stool. If needed, take stool softeners as directed by your doctor.

• Drink plenty of water. This prevents urine odor and dehydration. And follow any other diet instructions you’re given.

Follow-up care

You’ll have follow-up visits so your doctor can check how well you’re healing. Catheters will likely be removed after 2 to 3 weeks. If you have stitches that need to be removed, this will happen within 14 days (some stitches dissolve on their own). Tests may be done to make sure the stricture was repaired correctly and has healed well. And you may need more tests or procedures to ensure there are no problems after surgery.