Urethral reconstruction (urethroplasty) is a surgical treatment for a narrowed urethra (stricture). The procedure is considered for recurrent and long-segment strictures. Doctors treat first-time and short-segment urethral strictures with a urethrotomy. However, there is a high risk of recurrence with this approach, so urethral reconstruction is a more appropriate option if the condition recurs.
Urethral reconstruction is preceded by a detailed diagnosis of the location, size, and cause of the narrowing. The doctor uses X-rays to determine the location and size of the stricture. In some cases, a urethroscopy is also helpful in determining the appropriate method of reconstruction. Urethral stricture most commonly occurs in men, as they have a significantly longer urethra than women.
In men, the urethra (urethra masculina) is about 20 to 25 centimeters long @ PIC4U /AdobeStock
The causes of urethral stricture requiring urethral reconstruction vary:
- Frequent urinary tract infections (urethritis, ureteritis)
- Previous surgeries on the urinary tract
- Previous injuries resulting from an accident
- Use of a catheter
Your doctor may not always be able to identify the cause of the urethral stricture.
If urethral stricture is left untreated, there is a risk of developing bladder emptying problems over time. In this case, some urine remains in the bladder, leading to recurrent urinary tract infections.
The quality of life for patients with urethral stricture is often impaired. Urethral reconstruction is a procedure that has a high success rate of up to 90 percent.
Many patients have already undergone a urethrotomy before deciding to have reconstruction. However, this simple endoscopic procedure (performed using an endoscope) often loses its effectiveness after just a few months. Your doctor removes the stricture by incising it with a laser or scalpel. There is a high likelihood of recurrence.
The specialist for this procedure is a urologist with a focus on urological surgery. When reconstructing the urethra, your treating physician has various surgical techniques at their disposal.
In open urethral reconstruction, the focus is on surgically exposing the urethra and removing the stricture. The choice of procedure depends on your individual findings (length and location of the stricture).
- End-to-end anastomosis (connection)
With this method, your doctor excises the stricture from the urethra. This creates two ends (end-to-end), which he connects by placing a suture (anastomosis). This technique is suitable for extensive urethral injuries following an accident.
- Tissue Transfer Using a Mucosal Graft
Here, too, your doctor first surgically removes the narrowing in your urethra. The subsequent reconstruction is performed using an autologous graft (urethroplasty), such as one taken from the oral mucosa. The mucosa required is taken from the inner side of your cheek or the inside of your lower or upper lip.
This method is particularly suitable for long-segment strictures of the urethra. The procedure itself takes an average of 90 to 120 minutes. An anesthesiologist monitors your general anesthesia throughout the procedure. You will remain in the hospital for about five to seven days after the surgery.
In the first few days after surgery, a catheter in your bladder ensures that the surgical site heals properly. Once the catheter is removed, you will be discharged from the hospital. You will typically wear an abdominal catheter for a few days, which your doctor will remove during your follow-up care. Follow-up examinations are scheduled at regular intervals. During these visits, your doctor will assess the success of the procedure. Key criteria include the strength of your urine stream and whether your bladder is emptying properly.
Every surgical procedure carries general, rare risks, which your doctor will explain in detail during the preoperative consultation. In general, postoperative bleeding or inflammation in the wound area is possible, but these conditions are very treatable. You may experience temporary pain or mild numbness in the area around your mouth. In rare cases, scarring may occur.
The success of urethral reconstruction depends primarily on the surgeon’s experience. The long-term outcomes and extent of success depend on the specialist’s expertise. The long-term prognosis following reconstruction is very positive.
If left untreated, urethral strictures lead to urine retention. Ideally, your doctor will detect the stricture promptly and treat it. When urethral incision is used as a treatment method, relapse is common. Urethral reconstruction, on the other hand, is a helpful procedure with very good prospects for success that remain strong even in the long term.
