Proximal urethroplasty

What is this?

Open repair of the urethra for a stricture close to the bladder (occasionally performed immediately after severe injury to the urethra)

What alternatives are there?

Observation, optical urethrotomy, repeated stretching using metal/plastic dilators

What to expect before procedure

You will usually be admitted on the day before your surgery. You will normally 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. An incision is made over the stricture either on the penis or in the skin between the scrotum and the anus (the perineum). The scar is either cut away and the urethra re-joined over a catheter or widened with a piece of cheek lining (buccal mucosa) over a catheter. A drain will be inserted and, often, a second catheter placed in the bladder through the lower abdomen. The wound is closed with absorbable sutures. 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 in the perineum/scrotum be removed after 48-72 hours. The average hospital stay is 7 days.

Potential side effects