Urethroplasty

Urethral stricture and urethroplasty:

Urethral stricture is a surgery done to fix urethral strictures. Urethral stricture causes restriction of the urine flow and it can cause urine infection, bladder damage, and/or renal failure. The repair of the urethral stricture depends on many aspects including, location, length, calibre of the stricture and previous treatments. Some patients are treated with a graft and others might not require a graft. The decision will be made usually pre-operatively and sometimes intra-operatively. Patients would go home with the foley catheter and sometimes they might have a second catheter from the lower abdomen called supra-pubic catheter. Instructions for catheter removal are given after surgery and it usually stays between 1-3 weeks. 

Sequence of Treatment

The entire process of Urethroplasty includes:

1. Treatment Planning (via cystoscopy, retrograde urethrogram, and flow test).  Instructions for recovery will all be discussed in detail at this visit. Feel free to ask lots of questions at this appointment, this is your final visit prior to surgery.
2. Urethroplasty (with or without graft). 
3. Catheter removal post surgery (between 1-3 weeks and usually includes a retrograde urethrogram)
4. Follow up post surgery (cystoscopy, flow test)

Surgery:

The surgery is preformed in the hospital operating room. Patients usually go home from the recovery room. An anaesthesiologist will examine you, then put you to sleep. The surgery has two parts; the oral graft harvesting, and the urethral augmentation part. An Incision will be made in the mouth and a second incision will be made in the perineum or the penis depending on the stricture location and technique used. After the graft is placed and the urethra is closed over a catheter, the wound is closed in layers with dissolvable sutures.
Patients will be required to keep the catheter till the follow for the removal of the catheter. Diet will consist of 2 days of clear fluids, 2 days of full fluids, 2 days or pureed diet, and finally patient can eat solids on the other side of the cheek till the surgical site has healed. The first week should not have hot or spicy food. 

The foley catheter will stay and not to be removed by anyone but the urologist or the urologist delegate. Foley care will be done if needed but usually the catheter would be attached to the thigh till the follow-up visit. 

Patient are usually bothered with the mouth more than the perineal/penile incision. The perineal wound heals within 3 weeks and the dressing can be removed after 2 days with application of polysporin ointment or cream twice daily for 10 days. 

Follow-up after Surgery:

After most of your healing has taken place, The foley is removed and the patient is expected to void per urethra as usual. If the patient had a supra-pubic catheter, it is usually kept for few more weeks till Dr. Shahrour decides to have it removed. The removal of supra-pubic catheters is very simple and requires just simple deflation of the balloon and dressing on the opening which closes up in 2-4 days. 

After Your Surgery

Bleeding:  
 A small amount of bleeding can happen in the Foley. The perineal wound is usually dry but small amount of spotting is not concerning. Sometimes you will notice the scrotum or the labia to have a bruise that can appear black or blue and this is not worrisome unless it is expanding in size. 

Fluid Intake:
 Start to drink clear fluids as soon as you can in the hospital. You must be able to drink fluids for the I.V. to be removed. An average adult requires 2-3 litres of fluid/day. 

Pain or Discomfort:
 Each patient experiences differing amounts of pain depending on their procedure and level of tolerance. Patients will be given a prescription of narcotics and antibiotics. The usual amount of narcotics taken by patients can vary but usually are in the lower range.

Oral incision:
 Patients who receive buccal graft Urethroplasty would have an incision in the cheek. This incision takes 1-3 weeks to heal but it is usually closed. In rare cases it would be left open to heal on it own. Patients can use salt water washes to help with some of the small amount of blood that can be on the wound edges. The sutures are dissolving ones and patients usually feel swelling after the second day that goes away after 1 week.

Swelling/Bruising:
 After Urethroplasty, there might be swelling or bruising in the scrotum or labia. This swelling I snot concerning as long as it is not increasing in size. Elevation of the scrotum is very important in those situations.

Medications:
 You will be discharged home with oral narcotics and antibiotics.

Discharge:
 Patients are usually discharged from the recovery room within 2-3 hours after surgery. 

Sports and Exercise:
 You can resume your normal activities such as work or school 3-4 weeks after surgery, sometimes sooner.