Urethroplasty for Urethral Strictures

Stricture is scar tissue narrowing of the urethra, the tube through which one passes urine. This may arise from injury, previous surgery or catheterisation, infection, or, most commonly, without obvious cause. Stricture tends to cause obstructive urinary symptoms and, left untreated, bladder thickening, distension and dysfunction. Significant strictures should therefore be treated surgically. Short sharp strictures may be opened telescopically with a 50% cure rate. Those that recur and all longer complex strictures, require open urethroplasty.

Urethroplasty involves either:

1. excision of the scarred segment, rejoining the cut ends after mobilisation, or
2. opening through the scar and grafting tissue, commonly mucosa taken from the lining of the mouth

The operation is performed under general anaesthetic through a midline perineal incision, from the scrotum back to the anus. A short suprapubic incision may be needed to access the bladder. If mouth mucosa is used, this is taken from inside of the cheek. Urethral mobilisation may include re-routing the urethra around the penile bodies. Strictures towards the tip of the penis may be repaired in 2 stages.

Pre-operatively:

• discontinue aspirin 1 week prior
• some other medications may also need to be stopped
• enema the night prior, nil by mouth from midnight
• any shaving that is required will be performed in theatre

Post-operatively – early:

• 1st post-operative day: diet, reinstate usual medications
• gentle early mobilisation and antibiotics to ensure graft-take
• the urethral catheter must remain immobilised on the abdomen for 2 weeks, after which a urethrogram is done and catheters removed
• home on day 2-3, resume full normal activity by 4-6 weeks

Post-operatively – late:

• annual follow up with flow rate and urethroscopy/urethrogram, to < 10 years.

Although most cases proceed without particular difficulty and have excellent outcomes, surgical complications occur overall in 15% of patients. The most common and bothersome is restricturing, which may reflect an underlying process affecting the urethra. For this reason, follow-up is required. Although transient erectile changes may occur, the risk of long-term impotence is not increased by the surgery. Some patients will suffer impotence secondary to the original injury.

The list below details complications recognised as common or serious, but this does not include the rare and extraordinary.

This fact sheet complements the discussion during your consultation, which will apply your individual circumstances to the above facts.