Urethroplasty Surgery (Definitive Treatment for Urethral Stricture)
Urethroplasty is a reconstructive surgical procedure used to permanently treat urethral stricture disease, a condition in which scarring causes narrowing of the urethra and restricts urine flow. Unlike temporary treatments such as dilation or DVIU, urethroplasty provides a long-term solution by removing or reconstructing the narrowed segment of the urethra, restoring normal urine passage and improving quality of life.
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Surgical Repair of Urethral Stricture Using Urethroplasty
Urethroplasty involves surgically repairing or reconstructing the narrowed portion of the urethra. Depending on the length, location, and severity of the stricture, the procedure may involve excision of scar tissue with reconnection of healthy ends or reconstruction using tissue grafts. This surgery is considered the gold-standard treatment for moderate to severe urethral strictures.
How Urethroplasty Is Performed
Urethroplasty is performed under general or spinal anesthesia by a trained urologist.
Benefits of Urethroplasty Surgery
Urethroplasty provides the most effective and lasting treatment for urethral strictures.
Overview, Urethroplasty
The open reconstruction of urethral stricture disease, also called urethroplasty, may involve surgery to remove the involved segment and re-attach the two normal ends. This is called excision and primary anastomosis. This procedure is best suited for short strictures involving the bulbar or membranous urethra in particular. When this repair is not possible, tissue can be transferred to augment and therefore widen the narrow segment to a normal caliber. For example, the urethra can be augmented using penile skin. Other tissues that can be used to reconstruct the urethra include a graft of buccal mucosa (skin inside the cheek). When the above procedures are not an option, alternatives include a two-stage repair where a buccal mucosa and/or a split-thickness skin graft is placed along the undersurface of the penis, and later rolled into a new urethra (neo-urethra). The choice of repair is individual and influenced by the length and location of the stricture, the availability of local tissue, and other factors.
Recovery after Urethral Stricture Surgery
Subsequent to surgery, the length of hospitalization varies but generally does not exceed 5 days. Patients seldom have any significant pain or swelling in the penis or scrotum. However, if a buccal mucosa graft is harvested from the inside of the cheek, it is not uncommon for the mouth to be sore. This slowly resolves day by day, and pain medications are given as needed. Patients can immediately resume a normal diet after surgery. However, patients who undergo buccal mucosa graft harvests generally prefer a soft diet initially. When patients are discharged, they are encouraged to remain inactive for several weeks. Often, catheters remain for 2-3 weeks. We then remove the catheters after filling the bladder with x-ray contrast. Then, as the patient voids, a film is taken. This is a voiding cystourethrogram (VCUG). If the urethra is nicely healed, the patient leaves the office “tube free” and resumes normal urination. The vast majority of patients report a “night and day” difference in their stream, and often compare their stream to a “fire hose” as the change is often dramatic.
Success Rate of Urethroplasty
Urethroplasty has a very high success rate, often above 85–90%, making it the most reliable treatment for urethral stricture disease. Success depends on stricture type, length, and surgical technique used.
Preparation Before Urethroplasty
Before surgery, patients undergo imaging studies such as urethrogram, urine tests, blood investigations, and anesthesia evaluation. Active infections are treated beforehand. Proper preparation ensures safe surgery and smooth recovery.
Life After Urethroplasty Surgery
After successful urethroplasty, most patients enjoy normal urine flow without the need for repeated procedures. Regular follow-up helps ensure long-term success and urinary health.
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