Distal urethroplasty

What is this?

Open repair of the urethra for a stricture at the tip of the penis

What alternatives are there?

Observation, optical urethrotomy (cutting of the stricture under direct vision), repeated stretching using metal/plastic dilators

What to expect before procedure

You will usually be admitted on the day of your surgery and you will receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy. You will be given an injection under the skin of a drug (Clexane), that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the veins.

What happens during the procedure?

Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively. You will usually be given an injectable antibiotic before the procedure after checking for any drug allergies. The water pipe (urethra) can become scarred at any point along its length. At the distal end of the urethra, a common cause is a condition called balanitis xerotica obliterans (BXO) which is a particularly aggressive type of scarring with inflammation. When the urethra is affected by this condition, urethroplasty usually needs to be performed in at least two stages. The first stage involves opening the urethra from the tip of the penis down to normal urethra with a cut on the under surface of the penis. The scarred portion is then cut away and the graft, usually taken from the cheek lining (buccal mucosa) is laid in place and fixed with stitches so that the graft looks like a quilt. The skin on the under-surface of the penis is then stitched back to maintain the opening along the length of the previously scarred urethra. A catheter is inserted into the penis and this remains in place for approximately 1 week. The second stage of the repair cannot take place until at least 3 months after the first operation. It is essential that the graft picks up a good blood supply and, once this has occurred, it can be rolled into a tube, restoring the urethra to its normal calibre. On occasions, a further graft needs to be taken from the cheek at the second stage to ensure an adequate calibre for the urethra. After the second or subsequent stages, a catheter is usually inserted for a 2-3 week period. If a graft is taken from the cheek lining, this area heals quickly and does not require any stitches. A small dressing (pack) is usually inserted into the mouth overnight to prevent bruising or swelling.

After the procedure

If a graft has been taken from the cheek lining, a pack will be removed from your mouth the following day. Antiseptic and anaesthetic mouthwash will be used regularly and wide opening of the mouth is encouraged. The drain will be removed after 48-72 hours. The average hospital stay is 7 days.

Potential side effects