Name of the Procedure:

Total Urethrectomy with Cystostomy for Females
Alternate Names: Complete Urethrectomy, Urethral Removal with Cystostomy

Summary

In layman's terms, a total urethrectomy with a cystostomy for females is a surgical procedure that involves the complete removal of the urethra, often due to severe medical conditions like cancer. A cystostomy, which is the creation of an opening from the bladder to the skin's surface, is then performed to allow urine to bypass the removed urethra.

Purpose

The procedure is performed to address severe urethral diseases such as cancer, traumatic injury, or non-cancerous but obstructive lesions. The goal is to remove the unhealthy urethral tissue and ensure proper urine drainage through a cystostomy, thereby improving the patient’s quality of life and preventing potential complications from the diseased urethra.

Indications

• Urethral cancer or significant lesions
• Severe traumatic injuries to the urethra
• Obstructive urethral conditions that are unresponsive to other treatments
• Persistent infections or inflammation (less common)

Preparation

• Patients may need to fast for 8-12 hours before surgery.
• Adjustments to medications, especially blood thinners, under the guidance of a doctor.
• Pre-procedure assessments may include urine tests, imaging studies (like a CT scan or MRI), and blood tests.

Procedure Description

1. Anesthesia: General anesthesia is typically administered to ensure the patient is asleep and pain-free.
2. Incision: A surgical incision is made in the lower abdomen to access the bladder and urethra.
3. Urethrectomy: The urethra is carefully separated from surrounding tissues and completely removed.
4. Cystostomy: A small cut is made in the bladder to create a direct opening to the skin (stoma), and a tube (catheter) is inserted to allow urine to be collected in an external bag.
5. Closure: The surgical sites are then closed with sutures or staples, and dressings are applied.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity of the case.

Setting

The surgery is performed in a hospital setting within an operating room.

Personnel

• Surgeon (typically a urologist)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common: Infection, bleeding, pain at the surgical site
• Rare: Injury to surrounding organs, blood clots, anesthetic complications
• Management: Regular monitoring, antibiotics for infection, pain management strategies

Benefits

• Relief from symptoms caused by urethral disease (e.g., pain, urinary obstruction)
• Prevention of further complications from urethral conditions
• Improved quality of life

Recovery

• Hospital stay: 2-5 days for monitoring and initial recovery
• Pain management with prescribed medications
• Restrictions: Avoid heavy lifting or strenuous activity for 4-6 weeks
• Follow-up: Regular appointments to monitor healing and adjust the cystostomy

Alternatives

• Other surgical options like partial urethrectomy (if feasible and based on the location/extent of disease)
• Non-surgical treatments such as radiation or chemotherapy (specific to cancer)
• Pros and Cons: Many alternatives may not be as effective or suitable, particularly if the urethral condition is severe.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not experience pain. Post-procedure, moderate pain and discomfort around the surgical site are common, managed with medications. Patients will need to adapt to using a urinary catheter and will receive training and support to handle the cystostomy care. Regular follow-ups will ensure optimum recovery and address any complications promptly.