Urethroplasty

Urethroplasty

What is Urethroplasty?

Urethroplasty: Scar Tissue Repair of Urine Channel

Urethroplasty is the fixing of scar tissue in the urine channel from the bladder out the penis.  There are many surgeries possible to fix this and all work to increase the size of the urine channel to improve urine flow.

Why does scar tissue form in the urine channel?

There are many causes of this including prior injury, prior procedures such as catheter placement, prior surgery, or even sexually transmitted diseases.  A particular cause of scar formation known as Balanitis Xerotica Obliterans (BXO) can even effect a large portion of the penis both inside and out.

What problems would I have?

Anyone with a build up of scar tissue in the urine channel can have a slow urine stream or feel all the urine does not come out.  Some individuals develop a complete blockage and have no ability to urinate.  Other patients may feel pain with urination or have bladder infections.

What is done to determine if I have a blockage?

Prior to urethroplasty surgery it is important for all patients to have an x-ray test of the urethra to determine the location of the scar tissue.  Some patients may also undergo a uroflow test, urodynamics, or cystoscopy depending on the problems.

What types of repairs are available?

There are several options for fixing blockages of the urine channel.  Most scar tissue can be stretched open as a form of treatment but the scar can come back quickly with this procedure.  A camera and small scope can be used to guide a small knife to cut the scar open and usually a drainage tube is left in the penis.  In most cases this is useful for short scars or those that are new.  The longest lasting repair is urethroplasty.  In this procedure, the region of scar tissue is either removed or enlarged through a cut in the skin.  A small drainage tube (catheter) is left in place after surgery to allow the treated area to heal.

Will urethroplasty cause trouble having sex?

In general it is not likely to have trouble with sex after this surgery.  Some patients may have trouble with erections in addition to the urine channel blockage.  Both of these problems can be treated by your doctor.

Who performs a urethroplasty?

Many urologists feel confident to do the surgery but only about 10% do these surgeries often.

Does it leave a scar on the penis?

Most urethroplasty procedures are performed through the perineum, the region between the scrotum and the anus.  There are surgeries when the penis skin is used and a cut on the penis may be needed.  With care and good surgery, this rarely leads to scar tissue forming on the outside of the penis.

Does the procedure hurt?

Most people do have pain after the surgery, but the pain is usually not very bad.  Patients are given pain medication to limit the discomfort.  Some patients do not have any pain after surgery.

Catherter (drainage tube) care after surgery:

A small tube (catheter) about the size of cooked spaghetti will be placed in the penis for 10 to 20 days after surgery to allow it to heal.  The tube should be kept clean and taped to the skin to prevent movement.  A small amount of antibiotic ointment should be put daily at the penis opening to keep the catheter from sticking.

 

Recovery Guidelines for Urethroplasty

Most patients recover fairly quickly after the procedure but the swelling from the surgery may take weeks to get better.  In general it is recommended to limit activity to basic needs until the penis drain (catheter) is removed.  Pain should improve in the first week after surgery.

We highly recommend the following guidelines to facilitate healing:

Ice Pack

Ice packs may be used to stop scrotal and perineal swelling after surgery especially in the first 48 hours.  Be sure not to leave the ice in direct contact with the skin for much time.

Swelling

As mentioned, it is normal to have a scrotal swelling after surgery. Contact your surgeon if the swelling is severe (larger than a big orange) or if you are draining a large amount of fluid (soaking several pads per day).  Scrotal support in the form of a jock strap or tight underwear will help limit swelling.

Catheter (drainage tube) Care After Surgery

A small tube (catheter) about the size of cooked spaghetti will be placed in the penis for 10 to 20 days after surgery to allow it to heal.  The tube should be kept clean and taped to the skin to prevent movement.  The catheter should be cleaned at least once daily with soap and water.  A small amount of antibiotic ointment should be put daily at the penis opening to keep the catheter from sticking.  It is common for a small amount of urine to come out around the catheter, especially during bowel movements.

Incision Drainage

A small amount of blood may stain the dressings for 72 hours after surgery. This problem will resolve on its own. For the first few days, by adding two or three gauze pads to the surgical site, you will aid the healing process and help keep your clothes clean.

Bathing

You may begin to shower between 48-72 hours after surgery.  Allow the water to wash over the incision but do not scrub the incision.  Cover the taped portion of the catheter with saran wrap as well. Tub baths are not recommended in the first 7 days after surgery.  Swimming should be avoided during the first 2 weeks after surgery or until the catheter is removed.  Sitz baths are useful to decrease swelling and discomfort beginning about 7 days after surgery.

Stitches

Stitches will dissolve and do not need to be removed.

Pain Medication

In general you will be sent home with a few days of pain medication.  Use this only as needed.  After 48 hours, most patients can take extra strength Tylenol or ibuprofen for pain.

Normal Activity

Most patients remain hospitalized for a day or two after surgery.  Patients should limit their activity for 2 weeks minimum after surgery, or until the catheter is removed. You are advised to wear a scrotal support (jock strap) for a week. You may return to work when comfortable, but you should limit heavy lifting (greater than 20 pounds) or any extended walking or running.  Be sure to ask your surgeon about any restrictions prior to discharge from the hospital.

Sexual Activity

This varies based on the type of surgery.  Most patients need to wait until at least most swelling has resolved.  Be sure to ask your surgeon about when you can resume sexual activity.

When to Notify the Physician

Contact your surgeon if the swelling is severe or if you are draining a large amount of fluid (soaking several pads per day). Other reasons to contact your surgeon after urethroplasty include worsening pain, increased redness or tenderness around the incision site, drainage looking like pus from the incision, or a fever of greater than 101.  If you notice the catheter is not draining, try changing positions or drinking more fluid.  If this does not work, please call the office.