A Total Guide to Urethroplasty and Its Types

What is Urethroplasty Surgery?

Urethroplasty is a surgical procedure that is performed on the urethra which is a part of our urinary system. The main function of the urethra is to act as a outflow channel for urine from the urinary bladder. When the formation of scar tissue starts inside the urethra, surgery is needed.

The scar tissue (stricture) may involve varied lengths of the urethra; from as short as few millimeter to as much as whole length (6 inches or more). Therefore, based on the assessment before surgery, different types of urethroplasties may be employed. 

• For a short length of stricture in back part of urethra, scar tissue can be removed and healthy cut ends joined with self-degradable stitches. This procedure is called “end-to-end anastomotic urethroplasty”. The success of this procedure is upto 90 – 95%.  

• For longer lengths of stricture, the above procedure is usually not possible and a patch of tissue is required to widen the narrowed down part of urethra. This tissue is called graft or flap. Usually, tissues from the inside of the mouth or the cheek, and lips are used. This is medically called buccal mucosa. Skin can also be borrowed from the patient’s genitals such as the penis, labia, or vagina. This procedure is called “substitution urethroplasty”. Success of this type of urethroplasty is upto 75-80%. 

• Sometimes, in very complicated cases substitution urethroplasty is done in 2 stages (in males) – in the first stage, graft is placed and urethra is left open towards the underside of penis. The patient will have to sit on commode / or Indian toilet to urinate since back end of open urine tube is behind the scrotum from where urine will pass. This procedure allows to inspect initial healing of tissues and graft. Once the clinician is satisfied with healing process, second stage surgery is done (3 months after first surgery) and the opened urethra is closed with stitches upto front part of penis to enable the patient to pass urine normally. 

• Sometimes, in such complicated situations, if patient is elderly and cannot tolerate long surgery or 2 surgeries, rather than performing “substitution urethroplasty” or “2-stage urethroplasty” a permanent passage is created behind the scrotum (called “perineal urethrostomy”) after which the patient will have to pass urine in sitting position only (western commode or Indian toilet). The advantage of this approach is very short duration of surgery (typically one hour or less) and durable results (upto 95%, long term).  

The length of the whole surgery depends on the kind of repair that needs to be done. Joining two ends of the urethra comparatively takes lesser time than taking tissues from other parts of the body and then associating them with the urethra. Urethroplasty is the most recommended method to treat urethral strictures and to make the urine pass easily again with durable outcome.

Urethral Stricture

Urethral stricture is a condition of the urethra in which it starts contracting down and makes it difficult for the urine to pass through. The reduction in the hole also acts as a blocking agent because of which, again, the urine cannot flow normally.

The male population is more commonly affected by this condition compared to the females.

What Happens Before, During, and After Urethroplasty?

Before the actual surgery, an X-RAY named a retrograde urethrogram – voiding cystourethrogram (RGU-VCUG) is be performed to find out and finalize the length as well as the location of the blockage in the urethra (having a road-map). 

After these are done, you will be advised about your diet and activities that you need to follow before the surgery. Sometimes, the clinician may also suggest you get a catheter (tube) placed through lower part of abdomen directly into the urinary bladder to bypass urine away from urethra so as to allow rest to the urethra. The catheter also helps with the scars getting more well defined and easier to treat. 

During the urethroplasty surgery, the doctors will first reach the urethra by cutting down the muscle tissue and then find the scars. Based on the situation, the stricture will either be removed or will be widened by patch (graft / flap). After the process is completed, the wound will be stitched and the catheter will be passed through the surgery site into the bladder. This will help the urine to pass without any disturbance to the operated section and will help healing of surgery site. The catheter may be kept for 2 – 4 weeks depending on individual situation. 

You would not need to do much after the procedure is completed. The doctor may give you some pain medication, medication to keep the bladder at rest and teach how to take care of skin stitches and catheter. You will also need to take care of the area if the doctor has used extra tissues from any other body part.

Summary

Urethroplasty is a surgery used to treat your scarred urethra because of which it becomes difficult to pass urine. At all times, this procedure is safe and has a high success rate. However, have a talk with your health professional for more clarity over the same.