About Urethroplasty

Urethroplasty is a specialized surgical procedure aimed at repairing and reconstructing the urethra, the vital tube responsible for carrying urine from the bladder to the outside of the body. This surgery is often required to address conditions such as urethral strictures (narrowing due to scar tissue), traumatic injuries, or congenital abnormalities that impair urinary flow. Known as the gold standard treatment for urethral strictures, urethroplasty offers long-lasting solutions and better outcomes compared to less invasive methods like dilatations or ureterostomies.

What is Urethroplasty?

Urethroplasty is a specialized surgical procedure aimed at repairing and reconstructing the urethra, the vital tube responsible for carrying urine from the bladder to the outside of the body. 

Types of Urethroplasty

Urethroplasty procedures vary based on the severity and location of the urethral damage. Common types include:

• Anastomotic Urethroplasty: Ideal for short strictures, this involves removing the damaged section and stitching the healthy ends together. It boasts a high success rate of 90–95%.
• Buccal Mucosal Graft Urethroplasty: For longer or complex strictures, tissue from the inner cheek is used to reconstruct the urethra.
• Penile or Scrotal Flap Urethroplasty: Used for extensive repairs, this technique utilizes tissue flaps from nearby areas.
• Johansen’s Urethroplasty: Reserved for the most complex cases, involving complete reconstruction of the urethra.

Urethroplasty Procedure

• Preparation:
  • Patients undergo imaging tests like urethrography to determine the location and length of the stricture.
  • Routine pre-surgical screenings (e.g., lab tests, X-rays, EKGs) are conducted.
  • Patients are advised to fast (NPO) for 8–12 hours before surgery.
• Hospital Admission:
  • Upon arrival, patients are placed in a surgical gown and monitored for vital signs.
  • IV antibiotics and sedatives (e.g., diazepam or midazolam) are administered.

Operative Phase

1. Anesthesia

• General or regional anesthesia is administered based on the patient’s needs.

2. Positioning

• The patient is placed in the Lloyd-Davies or lithotomy position, with measures taken to prevent complications like compartment syndrome during prolonged surgeries.

3. Surgical Steps

• A suprapubic catheter is inserted into the bladder for urinary diversion during surgery.
• Incisions are made depending on the technique used:
  • For anastomotic urethroplasty, the damaged segment is excised, and the healthy ends of the urethra are stitched together.
  • For buccal mucosal graft urethroplasty, tissue from the inner cheek is harvested and grafted onto the affected area of the urethra.
  • Other techniques may involve skin flaps from the penis or scrotum.

4. Closure

• The incision is closed with absorbable stitches, and a catheter is left in place to allow healing while maintaining urine flow.

Recovery After Urethroplasty Surgery

1. Recovery:

• Most patients are discharged on the same day or after an overnight stay, depending on complexity.
• Pain medications, antibiotics, and bladder spasm prevention drugs may be prescribed.

2. Follow-Up Care:

• A Foley catheter remains in place for 2–3 weeks post-surgery.
• Follow-up appointments include imaging tests (e.g., X-rays with contrast) to ensure proper.

Advantages of Urethroplasty

Urethroplasty is a surgical procedure to repair or reconstruct the urethra, commonly used to treat urethral strictures. It offers several advantages over other treatment options, such as dilation or urethrotomy.

Key Benefits:

✔ Long-Term Success – Urethroplasty has a high success rate (over 85-90%) compared to temporary solutions like dilation or urethrotomy, which have higher recurrence rates.

✔ Permanent Stricture Relief – Unlike minimally invasive procedures that may require repeated treatments, urethroplasty provides a more durable solution.

✔ Improved Urinary Function – Patients experience better urinary flow and reduced discomfort after healing.

✔ Lower Risk of Recurrence – The chances of stricture returning are significantly lower than with endoscopic treatments.

✔ Customizable Approach – Different techniques (excision and primary anastomosis, grafts, or flaps) allow surgeons to tailor the procedure to each patient’s condition.

✔ Better Quality of Life – Relief from symptoms like pain, frequent infections, and urinary retention leads to a significant improvement in daily life.

✔ Minimally Invasive Options Available – While it is a surgical procedure, some approaches use minimally invasive techniques, reducing recovery time.