Urethral reconstruction (urethroplasty) is a surgical treatment for a narrowed urethra (stricture). The procedure is suitable for recurrent and long-standing strictures. Doctors treat first-time and short-segment urethral strictures with a urethral slit. However, there is a high risk of recurrence here, so urethral reconstruction makes more sense in the case of recurrent findings.
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 narrowing. In individual cases, an endoscopy of the urethra is also helpful to determine the appropriate method of reconstruction. Urethral stricture usually occurs in men, as they have a significantly longer urethra than women.
In men, the urethra (urethra masculina) is around 20 to 25 centimetres long @ PIC4U /AdobeStock
There are various reasons for a narrowing of the urethra that makes urethral reconstruction necessary:
Your doctor will not always find the cause of the urethral stricture.
If the urethral stricture is left untreated, there is a risk of bladder emptying disorders over time. Part of the urine remains in the bladder and repeatedly leads to urinary tract infections.
The quality of life of patients with a narrowing of the urethra is often limited. Urethral reconstruction is a method that has a high success rate of up to 90 percent.
Many patients have already undergone urethral slitting (urethrotomy) before deciding to undergo reconstruction. However, this simple endoscopic method (performed by endoscopy) often loses its effect after just a few months. Your doctor removes the narrowing by splitting it with a laser or knife. There is a high probability of recurrence.
The expert for this procedure is a urologist specializing in urological surgery. When reconstructing the urethra, your treating doctor has various options in terms of surgical techniques.
Open urethral reconstruction focuses on the surgical exposure of the urethra and the associated removal of the narrowing. The choice of procedure depends on your individual findings (length of the narrowing, position).
- End-to-end anastomosis (connection)
With this method, your doctor cuts the constriction out of the urethra. This creates two ends (end-to-end), which he then joins together by placing a suture (anastomosis). This technique is suitable for extensive injuries to the urethra following an accident.
- Tissue transfer using a transplant with mucosa
In this case, your doctor will also first surgically remove the constriction in your urethra. The subsequent reconstruction is carried out using an autologous transplant (urethroplasty), for example from the oral mucosa. The required mucosa comes from the inner side of your cheek or the inside of your lower or upper lip.
This method is particularly suitable for long-distance narrowing of the urethra. The procedure itself takes 90 to 120 minutes on average. A specialist anesthetist will monitor your general anesthesia during the procedure. You will stay in hospital for around five to seven days after the operation.
In the first few days after the operation, a catheter in your bladder will ensure that the operation site heals. Once the catheter has been removed, you will be discharged from hospital. You will usually wear an abdominal catheter for a few days, which your doctor will remove during your follow-up treatment. Check-ups will take place at regular intervals. Your doctor will check the success of the procedure. Important criteria are the strength of your urine stream and the correct emptying of the bladder.
Every surgical procedure is associated with general, rare risks, which your doctor will inform you about in detail during the consultation. In general, post-operative bleeding or inflammation in the wound area are possible, which are very easy to treat. You may experience temporary pain or slight numbness in the area of your mouth. In rare cases, scarring is possible.
Urethral reconstruction depends above all on thesurgeon's experience. The longevity and extent of success depend on the expertise of the specialist. The long-term prognosis after reconstruction is very positive.
If left untreated, narrowing of the urethra leads to a build-up of urine. Ideally, your doctor will recognize the narrowing promptly and treat it. Urethral slitting as a treatment method often leads to a relapse. Urethral reconstruction, on the other hand, is a helpful procedure with very good chances of success, even in the long term.
