Urethroplasty

 Urethroplasty is an open surgical reconstruction or replacement of the urethra that has been narrowed by scar tissue and spongiofibrosis (urethral stricture). Urethroplasty is the gold standard for urethal reconstruction with the best and most durable results.

UrethroplastyUrethroplasty is the repair of an injury or defect within the walls of the urethra. Trauma, iatrogenic injury and infections are the most common causes of urethral injury/defect requiring repair. Urethroplasty is regarded as the gold standard treatment for urethral strictures and offers better outcomes in terms of recurrence rates than dilatations and urethrotomies. It is probably the only useful modality of treatment for long and complex strictures though recurrence rates are higher for this difficult treatment group.

There are four commonly used types of urethroplasty performed; anastomotic, buccal mucosal onlay graft, scrotal or penile island flap (graft), and Johansen’s urethroplasty.

With an average operating room time of between three and eight hours, urethroplasty is not considered a minor operation. Patients who undergo a shorter duration procedure may have the convenience of returning home that same day (between 20% and 30% en total of urethroplasty patients). Hospital stays of two or three days duration are the average. More complex procedures may require a hospitalization of seven to ten days.

 

Types of operations

The choice of procedure is dependent on factors including:

  • physical condition of the patient
  • overall condition of the remainder of the urethra (not affected by the stricture)
  • the length of the defect (best determined by urethrography)
  • multiple or misaligned strictures
  • anatomical positioning of the defect with regard to the prostate gland, urinary sphincter, and ejaculatory duct
  • position of the most patent area of the urethral wall (necessary for determination of the location of the onlay/graft site, most often dorsal or ventral)
  • complications and scarring from previous surgery(ies), stent explantation (if applicable), and the condition of the urethral wall
  • availability of autograft tissue from the buccal cavity (buccal mucosa) (primary selection)
  • availability of autograft tissue from the penis and scrotum (secondary selection)
  • skill level and training of the surgeon performing the procedure

Note: in more complex cases, more than one type of procedure may be performed, especially where longer strictures exist.

How long does it take to heal from Urethroplasty?

A catheter remains in the urethra for two to three weeks after surgery to help with urination while the urethra heals. The long-term success rate of urethroplasty is high. About 80 percent to 90 percent of people who have had urethroplasty can expect permanent relief from urethral stricture.

 

What happens if your urethra is damaged?

Urethral strictures occur when the urethra is injured or scarred by an infection and then narrows. As a result, problems with the normal passage of urine and semen can develop. … Injuries that cause significant damage to the urethra may lead to urinary strictures or obstructions.

 

Can urethral strictures cause cancer?

The exact cause of urethral cancer is not known. But longtime swelling and infection may add to the risk. Many men with urethral cancer have been treated before for urethral stricture disease or sexually transmitted infections.

 

 

https://en.wikipedia.org/wiki/Urethroplasty

https://nyulangone.org/conditions/urethral-stricture-in-adults/treatments/surgery-for-urethral-stricture

https://www.ucsfhealth.org/conditions/urethral_injuries/

https://www.urologyhealth.org/urologic-conditions/urethral-cancer

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