Name of the Procedure:

Urethroplasty, 1-stage reconstruction of male anterior urethra

Summary

Urethroplasty is a surgical procedure used to reconstruct or repair the anterior part of the urethra in males. This single-stage technique involves removing the damaged section of the urethra and reconstructing it to restore normal urine flow.

Purpose

Urethroplasty addresses urethral strictures, which are narrowings of the urethra that can cause difficulty in urination. The goal is to remove the obstructed portion and reconstruct a functional urethra, thereby relieving urinary symptoms and improving quality of life.

Indications

• Difficulty or pain during urination
• Frequent urinary tract infections
• Weak urine stream or spraying urine
• History of trauma or prior surgeries affecting the urethra
• Confirmed diagnosis of urethral stricture via imaging or cystoscopy

Preparation

• Fasting for at least 8 hours before surgery
• Adjusting current medications as directed by the healthcare provider
• Completing pre-operative tests such as urinalysis, blood tests, and imaging studies

Procedure Description

1. Anesthesia: The patient is administered general or regional anesthesia.
2. Incision: A precise incision is made to access the urethra.
3. Excision: The scarred or narrowed section of the urethra is excised.
4. Reconstruction: A segment of tissue, often taken from another part of the body like the buccal mucosa (inner cheek), is grafted to reconstruct the urethra.
5. Closure: The reconstructed urethra is sutured, and the incision is closed.

Specialized surgical instruments and absorbable sutures are used throughout the procedure.

Duration

The procedure typically takes 2 to 4 hours, depending on the extent of the reconstruction needed.

Setting

Urethroplasty is performed in a hospital or specialized surgical center.

Personnel

• Urologist or specialized surgeon
• Surgical nurses
• Anesthesiologist

Risks and Complications

• Infection
• Bleeding
• Urethral fistula formation
• Scarring and recurrence of the stricture
• Urinary incontinence
• Erectile dysfunction (rare)

Management of complications involves antibiotics, further surgical interventions, or other medical treatments as required.

Benefits

• Alleviation of urinary symptoms
• Improved urine flow and stream
• Reduced risk of urinary tract infections
• Enhanced quality of life Improvements are often noted within a few weeks post-surgery.

Recovery

• Hospital stay of 1 to 2 days post-surgery
• Catheter placement for a few weeks to ensure proper healing
• Pain management with prescribed medications
• Instructions for catheter care and hygiene
• Follow-up appointments for catheter removal and assessment of the surgical outcome
• Avoiding strenuous activities for 4 to 6 weeks

Alternatives

• Urethral dilation: A less invasive procedure but often has temporary results and may require repeated sessions.
• Internal urethrotomy: Endoscopic procedure to incise the stricture, typically with a higher recurrence rate.
• Permanent catheterization or suprapubic catheter: When surgery is not feasible, although less desirable due to lifestyle impact.

Each alternative has its own advantages and disadvantages that should be discussed with a healthcare provider.

Patient Experience

• During the procedure, the patient is under anesthesia and should not feel pain.
• Post-operatively, mild to moderate pain and discomfort can be expected, managed by prescribed pain medications.
• Discomfort from the catheter presence can be alleviated with proper care and hygiene.
• Gradual improvement in urinary symptoms over the recovery period.

Pain management is an integral part of the post-operative care to ensure patient comfort.