Urethroplasty

Urethroplasty is a surgical procedure used to repair and reconstruct the urethra. It is the definitive treatment for urethral strictures, trauma, or congenital anomalies that impair normal urinary flow. Urethroplasty is preferred for its high success rate, long-term durability, and ability to restore normal function.

Indications

Urethroplasty is indicated for:

1. Urethral Strictures:
   • Narrowing caused by trauma, infection, inflammation, or iatrogenic injury.
2. Urethral Trauma:
   • Resulting from pelvic fractures, external injuries, or catheterization.
3. Congenital Urethral Anomalies:
   • Conditions like hypospadias or epispadias.
4. Fistulas:
   • Abnormal connections between the urethra and other organs or skin.
5. Recurrent Strictures:
   • Cases where previous treatments like dilation or urethrotomy have failed.

Types of Urethroplasty

1. Anastomotic Urethroplasty:

   • The stricture is excised, and the healthy ends of the urethra are reconnected.
   • Best for short strictures (<2 cm), particularly in the bulbar urethra.

2. Substitution Urethroplasty:

   • A tissue graft (e.g., buccal mucosa or skin) is used to reconstruct the urethra.
   • Suitable for long or complex strictures.

3. Staged Urethroplasty:

   • Performed in two stages, often used for severe or complex strictures.
   • The first stage involves opening the urethra and placing a graft.
   • The second stage tubularizes the graft to create a new urethral tube.

4. Perineal Urethroplasty:

   • Access through a perineal incision, typically for posterior urethral strictures.

5. Penile Urethroplasty:

   • Used for strictures in the penile urethra, often requiring grafts or flaps.

Preoperative Preparation

1. Diagnostic Workup:

   • Urethroscopy: Direct visualization of the stricture.
   • Retrograde Urethrogram (RUG): Imaging to assess the location and length of the stricture.
   • Voiding Cystourethrogram (VCUG): Evaluates the urinary tract during voiding.
   • Urinalysis: To rule out infection.

2. Patient Counseling:

   • Discuss the procedure, success rates, risks, and recovery expectations.

3. Anesthesia:

   • General or regional anesthesia is used for urethroplasty.

Surgical Procedure

1. Incision and Exposure:

   • The urethra is accessed through a perineal or penile incision, depending on the stricture’s location.

2. Stricture Excision or Reconstruction:

   • In anastomotic urethroplasty, the narrowed segment is excised, and the healthy ends are sutured together.
   • In substitution urethroplasty, a graft or flap is harvested (e.g., buccal mucosa from the cheek) and used to reconstruct the urethra.

3. Suturing:

   • Fine absorbable sutures are used to ensure a tension-free, watertight repair.

4. Catheter Placement:

   • A Foley catheter is inserted to allow healing and facilitate urine drainage.

5. Closure:

   • The incision is closed in layers, ensuring proper hemostasis.

Postoperative Care

1. Hospital Stay:

   • Typically 1-3 days, depending on the complexity of the procedure.

2. Catheter Management:

   • The catheter is usually left in place for 2-3 weeks to support healing.

3. Pain Management:

   • Analgesics and anti-inflammatory medications are prescribed.

4. Antibiotics:

   • To prevent infection.

5. Activity Restrictions:

   • Avoid heavy lifting, vigorous exercise, or sexual activity for 4-6 weeks.

Follow-Up Care

1. Catheter Removal:

   • After 2-3 weeks, the catheter is removed, and the urethra is assessed.

2. Imaging:

   • A voiding cystourethrogram (VCUG) is performed to check for leaks or residual stricture.

3. Monitoring:

   • Regular follow-ups to evaluate urinary flow and detect any recurrence.

Benefits

• Relief from urinary symptoms.
• Improved quality of life.
• Long-term resolution of urethral stricture.
• Preservation of urinary and sexual function.

Risks and Complications

• Infection: Urinary or surgical site infection.
• Bleeding: Rare but possible.