Name of the Procedure:

Closure of Urethrostomy or Urethrocutaneous Fistula, Male

• Technical Terms: Urethrostomy Closure, Urethrocutaneous Fistula Repair

Summary

This procedure is a surgical intervention to close an unnatural opening between the urethra and the skin, which can result from previous surgeries, trauma, or congenital conditions.

Purpose

The procedure addresses excessive urinary leakage and improves urinary function and comfort by sealing the abnormal passage.

Indications

• Persistent urinary leakage from a fistula
• Recurrent urinary tract infections
• Pain or discomfort associated with the fistula
• Cosmetic and functional concerns

Preparation

• Patients may be required to fast for several hours before the procedure.
• Adjustments to medications, especially blood thinners, may be necessary.
• Pre-procedure imaging (ultrasound, MRI) or cystoscopy to assess the fistula.

Procedure Description

1. Anesthesia: General or regional anesthesia is typically administered.
2. Incision: A precise incision is made to access the fistula.
3. Dissection: The fistula tract is carefully dissected and separated from surrounding tissues.
4. Closure: The urethral and skin openings are closed in layers to prevent recurrence.
5. Catheterization: A temporary catheter may be placed to ensure proper urinary drainage during the healing process.
   • Tools: Surgical instruments including scalpels, sutures, and clamps.

Duration

Approximately 1 to 2 hours, depending on the complexity.

Setting

Performed in a hospital or specialized surgical center.

Personnel

• Urologist or specialized surgeon
• Surgical nurses
• Anesthesiologist

Risks and Complications

• Common: Infection, bleeding, pain.
• Rare: Recurrence of the fistula, urinary incontinence, scarring, and urethral stricture.

Benefits

• Elimination of urinary leakage through the fistula.
• Improved urinary function.
• Reduction in related infections and discomfort.
• Benefits are typically realized within a few weeks post-surgery.

Recovery

• Post-procedure care includes pain management, antibiotics, and possibly catheter care.
• Avoid heavy lifting and strenuous activities for several weeks.
• Follow-up appointments to monitor healing and remove the catheter.

Alternatives

• Continual use of protective garments for urinary leakage.
• Non-surgical management with catheters or stenting.
• Trade-offs: Surgical closure generally offers a more permanent solution compared to ongoing conservative management.

Patient Experience

• Patients may feel groggy and mild discomfort post-anesthesia.
• Pain at the surgical site is expected but manageable with prescribed medications.
• A catheter may cause initial discomfort.
• Most patients can resume light activities within a few days, with full recovery taking several weeks.