53420 Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; first stage

Name of the Procedure:

Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; first stage.

Summary

Urethroplasty is a surgical procedure aimed at reconstructing or repairing the damaged urethra. In a 2-stage reconstruction, the first stage involves creating an initial repair framework to facilitate urethral healing and function before finalizing the reconstruction in the second stage.

Purpose

This procedure addresses urethral strictures, trauma, or disease affecting the prostatic or membranous urethra. The goal is to restore normal urine flow, alleviate symptoms, and prevent complications like urinary retention and infections.

Indications

• Severe urethral stricture or obstruction
• Trauma to the prostatic or membranous urethra
• Chronic inflammation or infection leading to urethral damage
• Recurrent urinary tract infections (UTIs)
• Previous failed urethral repair or reconstruction

Preparation

• Fasting as directed, typically starting midnight before the procedure.
• Adjustments to medications, especially blood thinners.
• Preoperative diagnostic tests such as urodynamics, cystoscopy, and imaging studies to assess the urethral damage.
• Bowel preparation if required.

Procedure Description

1. Administration of general or regional anesthesia.
2. An incision is made in the perineum (area between the scrotum and anus).
3. The surgeon assesses the damaged section of the urethra.
4. Diseased or scarred tissue is excised.
5. A graft, usually from buccal mucosa (inner cheek), is harvested and applied to the affected area creating a new urethral segment.
6. Temporary urinary diversion, like a suprapubic catheter, may be placed to allow healing.
7. Wound closure and application of a sterile dressing.

Duration

Approximately 2-4 hours, depending on the complexity of the case.

Setting

Typically performed in a hospital operating room.

Personnel

• Urologic surgeon
• Anesthesiologist
• Surgical nurses and technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma
• Graft failure or scarring
• Urethral fistula formation
• Urinary incontinence

Benefits

• Improved urine flow and reduction of obstructive symptoms
• Resolution of recurrent UTIs
• Long-term durability of urethral repair
• Enhanced quality of life

Recovery

• Hospital stay for a few days post-surgery.
• Pain management with prescribed medications.
• Activity restrictions including avoidance of heavy lifting and strenuous activity for several weeks.
• Regular follow-up appointments for monitoring progress.
• Removal of catheter after a few weeks based on healing status.

Alternatives

• Dilation or urethrotomy, though less effective for severe cases.
• Permanent urinary diversion, which is more invasive.
• Observation and management of symptoms without surgery for mild cases.

Patient Experience

Patients should expect some discomfort and swelling at the incision site, managed with pain relievers. Urinary catheter use may be uncomfortable but necessary for healing. Gradual improvement in urinary function is expected as the surgical site heals over weeks to months. Regular follow-up ensures early detection and management of any complications.