Name of the Procedure:

Plastic repair of urethrocele
Common name(s): Urethrocele repair
Medical term: Urethroplexy or Urethral Reconstruction

Summary

Plastic repair of a urethrocele is a surgical procedure to correct a prolapse or herniation of the urethra into the vaginal wall. This condition can cause discomfort, urinary issues, and incontinence. The surgery involves repositioning and reinforcing the tissues around the urethra to restore normal anatomy and function.

Purpose

This procedure addresses the prolapse of the urethra, known as a urethrocele, which often results in urinary incontinence, discomfort, and irritation. The goals are to alleviate symptoms, improve urinary function, and enhance the patient's quality of life by restoring the normal position of the urethra.

Indications

• Symptoms of urinary incontinence.
• Discomfort or pressure in the vaginal area.
• Recurrent urinary tract infections.
• Visible or palpable bulge at the vaginal opening.
• Failure of conservative treatments like pelvic floor exercises.

Preparation

• Patients may be required to fast for 8 hours before the procedure.
• Adjustments or discontinuation of certain medications (e.g., blood thinners) as advised by the doctor.
• Preoperative diagnostic tests such as urinalysis, pelvic ultrasound, or urodynamic studies.

Procedure Description

1. The patient is placed under general or regional anesthesia.
2. A surgical incision is made in the vaginal wall to access the urethra.
3. The surgeon repositions the urethra and reinforces the surrounding tissues using sutures or a surgical mesh.
4. The vaginal wall is then closed with absorbable stitches.
5. A catheter may be temporarily placed to ensure proper urinary function post-surgery.

Duration

The procedure typically takes 1 to 2 hours.

Setting

Plastic repair of urethrocele is usually performed in a hospital, either as an inpatient or outpatient procedure, depending on the patient's condition.

Personnel

• Urologist or gynecologist specializing in pelvic floor disorders.
• Anesthesiologist.
• Surgical nurses.
• Operating room technician.

Risks and Complications

• Infection.
• Bleeding.
• Injury to surrounding organs (bladder, bowel).
• Urinary retention or difficulty urinating.
• Recurrence of urethrocele.
• Pain or discomfort during intercourse.

Benefits

• Reduced urinary incontinence and associated symptoms.
• Improved comfort and quality of life.
• Potential reduction in recurrent urinary tract infections.
• Enhanced sexual function.

Recovery

• Patients may experience some discomfort and swelling, which is managed with pain medication.
• Avoid heavy lifting, strenuous activities, and sexual intercourse for 4 to 6 weeks.
• Follow-up appointments to monitor healing and assess urinary function.
• Return to normal activities typically within 4 to 6 weeks post-surgery.

Alternatives

• Pelvic floor physical therapy.
• Use of a pessary (a device to support the urethra).
• Lifestyle changes such as weight loss and bladder training.
• Injectable bulking agents to the urethral wall.

Patient Experience

• During the procedure: Patients are under anesthesia and will not feel pain.
• After the procedure: Mild to moderate pain managed with medication. Possible discomfort with urination initially.
• Short-term: Swelling and temporary limitations on physical activities.
• Long-term: Improved symptoms and quality of life with ongoing care and follow-up.