Proximal Urethroplasty

Overview

Proximal Urethroplasty is an open repair of the urethra for any stricture nearby the bladder. The operation is sometimes done on an emergency basis after severe injury to the urethra.

Defects or injuries to the wall of the urethra are caused due to trauma, infections and iatrogenic injury. The procedure of Urethroplasty is considered as the gold standard treatment for strictures with optimal outcome in terms of recurrence rates.

It is a complex operational procedure that may take time up to eight hours. However, it takes lesser time for some patients, depending upon their condition, and in that case they are allowed to go home on the same day.

Proximal Urethroplasty operation may require the patient to stay 2-3 days in the hospital, but this can go up to 8-10 days in case of a more critical condition. The time taken for the operation and post-operative recovery of proximal urethroplasty depend upon several factors:

• Physical condition of the patient
• Misaligned or multiple strictures
• Overall condition of the urethra
• Extent of the defect in the urethra or urethra walls
• Anatomical position of the defects
• Scarring and complications in the inner walls of the urethra from previous surgeries
• Training, expertise and skill level of the surgeons

There are three most significant phases of the operation that the patient has to go through- pre-operative, surgery and post-operative phases.

Before the treatment

This is the pre-operative phase, where a patient has to make some preparations before proximal urethroplasty operation. They include:

• Ideally, the patient has to visit the doctor and get a thorough physical examination. The doctors perform an urethroplasty to see the length of the urethra, its condition and position close to the bladder. You will have to undergo pre-surgical screening or testing for the evaluation of your health. Make sure you do not eat or drink anything 8-12 hours before the assessments.
• Disclose all details about your health to the doctor. If you have any other medical concern, tell your doctor about the medications you are taking. If they include aspirins or blood thinners, you are most likely to stop taking them before the surgery.
• Avoid drinking or eating anything from the midnight till the day of surgery.
• On reaching the hospital on the day of surgery, you are advised to change into a surgical gown and lie down on a receiving bed. You will be monitored for blood pressure, heartbeat, etc. An IV channel is created into your arm for a normal saline IV drip. Pre-medications like IV antibiotics are also started.

How it is performed

It is the second phase of proximal urethroplasty that involves:

• You are taken to the operating room where anaesthesia is given to help you sleep through the surgery. The types of anaesthesia given depend upon the medical condition of the patient and the surgery.
• An incision is done over the stricture, either in between the anus and the scrotum or on the skin of the penis. The scarred tissues are cut and removed and the urethra is widened with a buccal mucosa (cheek lining) or re-joined over a catheter.
• A suprabutic drain catheter (also called a drainage system) is inserted into the urinary bladder through the lower abdomen.
• Once, the operation is done, the open wounds are closed with absorbable sutures.
• If any graft was taken from the cheek lining, no stitches are required since the wound will heal by itself. However, a small dressing pack may be inserted into the mouth to prevent swelling or bruising.

Recovery

Post-operative care is most important since it ensures quicker recovery of the patient. You may have to stay 5-7 days after the surgery during which the drain catheter is removed from your bladder on the second or third day of the surgery. You are restricted from any strenuous activities for 2-3 days after the surgery.

It should be noted that a complete proximal urethroplasty recovery takes 6 to 8 weeks. Make sure you listen to your doctor’s advices and restrictions and have the required medications for a speedier recovery. In case of any severe signs of proximal urethroplasty surgery like bruising and swelling of the wound, injury to the urethra and recurrent stricture, talk to your doctor immediately.