Name of the Procedure:

Urethrectomy, total, including cystostomy; male

Summary

A total urethrectomy with cystostomy in males is a surgical procedure that involves the complete removal of the urethra, combined with the creation of an opening in the bladder called a cystostomy. This allows urine to be diverted from the bladder through a new route, typically to a collection bag outside the body.

Purpose

This procedure is performed to treat severe conditions of the urethra such as extensive urethral cancer, recurrent severe urethral stricture disease, or severe trauma that cannot be repaired. The goal is to remove the diseased tissue and provide an alternative pathway for urine to exit the body, thereby alleviating symptoms and preventing further complications.

Indications

• Urethral cancer
• Severe or recurrent urethral strictures
• Traumatic injury to the urethra
• Conditions resulting in severe damage to the urethra that cannot be repaired

Preparation

• Fasting for at least 8 hours prior to the procedure
• Adjustment or temporary discontinuation of certain medications as directed by the physician
• Preoperative blood tests, imaging studies (like ultrasound, CT, or MRI), and possibly a cystoscopy to evaluate the urethra and bladder

Procedure Description

1. The procedure is usually performed under general anesthesia.
2. An incision is made in the perineum (the area between the scrotum and anus) to access and remove the urethra.
3. Simultaneously, a surgical opening (cystostomy) is created in the bladder through the lower abdomen to connect it to an external collection system for urine drainage.
4. Catheters or stents might be placed to ensure proper urine flow.
5. The surgical sites are then closed, and sterile dressings are applied.

Duration

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

Setting

This surgery is performed in a hospital setting, specifically within an operating room that is part of the urology department or surgical unit.

Personnel

• Urologic surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technologists

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Damage to nearby organs
• Issues with the cystostomy such as blockage or leakage
• Risks associated with general anesthesia
• Long-term changes in urination patterns

Benefits

• Removal of diseased or damaged urethra
• Alleviation of symptoms like obstruction, pain, or bleeding
• Prevention of complications from untreated urethral conditions
• Improved quality of life by managing underlying health issues

Recovery

• Hospital stay of several days post-surgery for monitoring
• Pain management with prescribed medications
• Instructions on care for the cystostomy site
• Limited physical activity for several weeks
• Follow-up appointments to monitor healing and functionality
• Possible physical therapy for pelvic floor muscles

Alternatives

• Urethral dilation or stenting for strictures (less invasive but may not be effective long-term)
• Partial urethrectomy if only part of the urethra is affected
• Advanced reconstructive surgery (may be considered depending on the extent of damage)
• Conservative management with regular monitoring (not suitable for cancer but may work for minor strictures)

Patient Experience

Patients might feel significant discomfort and need help with mobility and daily activities initially. Pain management will be a priority. The presence of a urinary collection bag requires adaptation and hygiene considerations. Emotional support and counseling might be beneficial during recovery.

This text offers a thorough yet comprehensible explanation of the urethrectomy with cystostomy procedure for males, suitable for patients seeking to understand the process and implications of this surgery.