53415 Urethroplasty, transpubic or perineal, 1-stage, for reconstruction or repair of prostatic or membranous urethra

Name of the Procedure:

Urethroplasty, transpubic or perineal, 1-stage, for reconstruction or repair of prostatic or membranous urethra

Summary

Urethroplasty is a surgical procedure aimed at reconstructing or repairing the urethra. This specific type involves a one-stage transpubic or perineal approach to address issues in the prostatic or membranous section of the urethra.

Purpose

This procedure addresses urethral strictures or injuries in the prostatic or membranous regions. The goal is to restore normal urine flow and improve urinary function by repairing the damaged urethra.

Indications

• Severe urinary obstruction or difficulty urinating.
• Trauma or injury to the urethra.
• Urethral strictures unresponsive to other treatments.
• Complications from previous urethral surgeries or treatments.

Preparation

• Patients may need to fast for a specified period before the surgery.
• Preoperative tests may include urine analysis, imaging studies (like urethrogram), and blood tests.
• Adjustment or cessation of certain medications, as advised by the surgeon.

Procedure Description

1. The patient is administered general or regional anesthesia.
2. An incision is made, either transpubically (through the pelvic bone) or perineally (through the area between the scrotum and rectum).
3. The surgeon locates and isolates the damaged portion of the urethra.
4. The affected section is then repaired or reconstructed using grafts or surrounding tissues.
5. Closed in layers, ensuring minimal tension on the repaired area.
6. A catheter is inserted to aid in the healing process and ensure urine flow post-surgery.

Duration

The procedure typically lasts between 2 to 4 hours.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Urologic surgeon
• Surgical nurses
• Anesthesiologist
• Surgical assistants

Risks and Complications

• Infection
• Bleeding
• Urinary incontinence
• Recurrence of stricture
• Erectile dysfunction
• Anesthetic complications

Benefits

• Restored urine flow.
• Relief from urinary discomfort and obstruction.
• Improved quality of life.

Recovery

• Patients may need to stay in the hospital for a few days post-surgery.
• Catheter typically remains in place for 2 to 3 weeks.
• Pain management through prescribed medications.
• Advice to avoid strenuous activities and follow a specific diet.
• Follow-up appointments to monitor healing and catheter removal.

Alternatives

• Urethral dilation or internal urethrotomy.
• Permanent urinary diversion.
• Periodic self-catheterization. Each alternative carries its own risks and benefits compared to urethroplasty.

Patient Experience

Patients may experience discomfort and require pain management immediately post-surgery. Gradually, as healing progresses, normal urinary function should be restored. The presence of a catheter might be inconvenient, but it's essential for proper healing. Overall, most patients report significant improvement in urinary function after recovery.