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What is Urethroplasty?
Urethroplasty is an open surgical reconstruction or replacement of the urethra that has been narrowed by scar tissue and spongiofibrosis (urethral stricture). Urethroplasty is the gold standard for urethal reconstruction with the best and most durable results.
A flap is a transfer of tissue from one part of the body to another, where the donor blood supply is left intact. Penile flap urethroplasty uses a flap of penile skin to reconstruct a urethral stricture that does not rely on the scarred urethra for its survival. Penile skin flaps are good for reconstructing long strictures of the penile urethra. Penile skin flaps are versatile and are used as a patch to the narrow urethral segments. Success rates in the short term approach 80-85%. Flaps that are rolled into a tube have nearly a 50 percent failure rate – so flaps are reserved for patching and not replacement. Skin flaps from the scrotum should be avoided in urethroplasty, as their complication rate is high and their success rates poor.
A urethral stricture results from trauma either from an injury such as a car or bike accident or complications from a medical procedure such as a urethral catheter placement, radiation treatment, or prostate surgery. Occasionally, an infection of the urethra or gonorrhea (a sexually transmitted disease) can cause a urethral stricture.
To test for a urethral stricture, we might perform a physical exam or one of these diagnostic tests:
Imaging test with X-rays called a retrograde urethrogram (with contrast dye) to assess the length of the stricture and density of the stricture
Urine flow test and ultrasound to see how the urine flow is affected by the urethral stricture
Ultrasound to determine if you have more than usual urine left in your bladder after urination
Cystoscopy, where we gently insert a small, bendable, lubricated fiber optic scope into your urethra under local anesthesia to see the location and appearance of the stricture
There are several treatment options for a urethral stricture, depending on how large the blockage is and how much scar tissue you have.
Treatment options for a urethral stricture include:
Active surveillance, which means closely monitoring the stricture
Dilating or stretching the stricture to treat the symptoms
Urethrotomy, or cutting the stricture through a scope
Urethroplasty, or surgical reconstruction of the urethra; which is often the most effective approach
If you have a light, filmy, short stricture without a lot of scar tissue in the urethral sponge (called spongiofibrosis), we often chose to treat with active surveillance, urethral dilation, or an endoscopic incision of the urethra, rather than a surgical procedure. If, on the other hand, you have a recurrent stricture or a dense or long stricture, we are more likely to perform a urethroplasty. We perform an urethroplasty in the hospital, under general anesthesia. This delicate procedure generally fixes the urethral stricture as well as any spongiofibrosis. Most of the time, it is a permanent cure. We perform an urethroplasty by removing the part of the urethra with the stricture and scar tissue. If it is a long stricture, we may also add new tissue, such as a graft from the mouth (a buccal mucosal graft) or a flap of skin to help reshape urethra.
After the surgery
You may stay in the hospital for a day or two and have a urinary catheter in for two or three weeks. Most people experience dramatic and long-lasting improvement in urinary symptoms. If you have a lot of scar tissue, it is possible that the stricture may recur.
Each stricture is unique in its length and appearance and each patient is also unique with different needs and circumstances. Because of this we individualize stricture treatment using our extensive experience to make sure you will have the best outcome.
Female Urethral Strictures
Although less common, women can also have urethral strictures and our urologists are internationally recognized as experts in treating this problem. The cause and treatments of female urethral strictures are different from men but for women the urethral scar tissue can also cause bothersome urinary problems such as urinary urgency and frequency, slow stream, needing to push to urinate as well as urinary tract infection, pain, and bleeding.
Typically the scar tissue in the female urethra can be treated with dilation of the urethra or cutting the urethral stricture through a small scope inserted in the urethra. We are one of the few centers in the United States that can offer additional treatments for refractory urethral strictures and often see women with urethral strictures in whom these treatment options have failed. For these recurrent strictures, local skin from around the vagina can be used to reconstruct the urethra. We have had significant success using grafts from the inside of the mouth (buccal mucosal grafts) to repair more complicated strictures.
The longest lasting repair is urethroplasty. In this procedure, the region of scar tissue is either removed or enlarged through a cut in the skin. A small drainage tube (catheter) is left in place after surgery to allow the treated area to heal.
Surgery time varies because each surgery and patient is unique. In general, the procedure takes three hours, but it can range from 2 to 5 hours, depending on the severity of the scar tissue and the extent of the reconstruction.
In addition to psychogenic factors, erectile dysfunction (ED) after urethroplasty may be due to damage to the cavernous nerve, damage to the perineal nerve, and deterioration of the flow of the bulbar artery.
Most of the time, it is a permanent cure. We perform a urethroplasty by removing the part of the urethra with the stricture and scar tissue. If it is a long stricture, we may also add new tissue, such as a graft from the mouth (a buccal mucosal graft) or a flap of skin to help reshape urethra.
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