Urethroplasty (Urethral Reconstruction)

What is urethroplasty?

A urethral stricture is scar tissue that narrows the urethra and blocks urine flow. Urethroplasty is open reconstruction of that segment. Short strictures may be excised and the healthy ends rejoined. Longer strictures are widened using a graft, most often buccal mucosa taken from the inside of the cheek, which heals quickly and is well suited to a wet environment.

Who may benefit?

• Men with recurrent stricture after dilation or internal urethrotomy.
• Men with long or dense strictures.
• Men with strictures after trauma, catheterization, infection, or prior surgery.
• Men who want a durable solution rather than repeated procedures.

How is the procedure performed?

Under general anesthesia through a perineal or penile incision, the strictured segment is exposed and either removed and reconnected or opened and patched with a graft. The operation typically takes two to four hours. Most patients go home the same day or after one night.

What are the benefits?

• Long-term success rates that are substantially higher than repeat dilation.
• Ends the cycle of repeated procedures and catheters.
• Restores normal flow and bladder emptying.

What are the alternatives?

Urethral dilation, internal urethrotomy, self-catheterization to maintain patency, or a permanent suprapubic catheter. These are less invasive but far more likely to require repeat treatment.

What are the risks?

• Stricture recurrence, which is uncommon but possible.
• Wound infection or hematoma.
• Temporary numbness, cheek tightness, or altered sensation at the graft site.
• Changes in ejaculation, spraying of the stream, or penile curvature in some reconstructions.
• Erectile changes, usually temporary.

What should I expect before surgery?

• A pre-operative visit to review your history, medications, and goals.
• Instructions on blood thinners, supplements, and diabetes medications.
• A urine culture so any infection is treated before the procedure.
• Nothing to eat or drink after midnight unless told otherwise.
• A responsible adult to drive you home on the day of surgery.

Will I have a catheter?

Yes. You will typically have two catheters: one through the urethra (the urine channel) and one through the lower belly, called a suprapubic catheter. They usually stay in place for four to six weeks depending on the stricture length, location, and complexity of the repair. Before removal, a small amount of contrast dye is used to study the urethra (a urethrogram) to confirm the repair has healed without leakage. The suprapubic catheter is then capped and your voiding is followed in the clinic.

What should I expect during recovery?

• Perineal soreness and bruising for two to three weeks.
• Sit on a cushion and avoid straddling activities.
• No lifting, cycling, or sexual activity for four to six weeks.
• If a cheek graft was used, expect a soft diet and mouth soreness for several days.

When should I call the office?

• Fever above 101.5°F or shaking chills.
• Inability to urinate, or a catheter that stops draining.
• Heavy bleeding, or clots that do not clear with increased fluids.
• Pain that is not controlled by your prescribed medication.
• Redness, swelling, or drainage at an incision site.