Urethroplasty Synonym: Repair of Urethral Stricture What is Urethroplasty?

Urethroplasty is an open surgical procedure for urethral reconstruction to treat urethral stricture. Urethroplasty can be performed by 2 methods; primary repair which involves complete excision of the narrowed part of the urethra. The proximal and distal patent parts are then rejoined. The second method of Urethroplasty utilizes tissue transfer or free graft technique. In this method tissue is grafted from bladder epithelium or buccal mucosa and is used to enlarge the strictured !narrowed" segment of the urethra. Who is an ideal candidate for Urethroplasty? If you have a urethral stricture due to any of the causes i.e. repeated episodes of urethritis benign prostatic hyperplasia scarring from a previous surgery injury or trauma most commonly to the pelvic region or from pressure of a tumour then you are an ideal candidate for Urethroplasty. How do I prepare for Urethroplasty? # thorough pre$operative assessment by your urologist would comprise of physical examination urinalysis for the presence of blood and white cells urine culture for infection and Cystoscopy to confirm the diagnosis of urethral stricture. The standard urethral imaging procedures li%e &etrograde 'rethrogram !&'(" and )oiding *ystourethrogram !)*'(" will be performed. +ou will be hospitalized at least one day before the surgery. Inform your surgeon about your other health conditions and medications !including all the prescription non$prescription medications nutritional supplements i.e. vitamins minerals and herbal products". &efrain from ta%ing aspirin or Ibuprofen at least 2 wee%s before Urethroplasty. ,top smo%ing a few wee%s before Urethroplasty to prevent healing problems during recovery period. -o not eat or drin% any thing for at least ./ $ .2 hours before the Urethroplasty. What does Urethroplasty procedure involve? Urethroplasty is performed under general anesthesia. Two Urethroplasty techniques are popularly used0 #nastomotic Technique $ In this method of Urethroplasty the narrowed part of the urethra is cut and the proximal and distal parts of the urethra are re$joined a foley1s catheter will be left in for the next 2 wee%s to ensure complete healing and repair. This method of Urethroplasty is used for small urethral strictures i.e. less than 2 cm wide. Tissue Transfer $ In this method of Urethroplasty Skin and Tissue is rafted from a non$hair bearing part of the body li%e the buccal mucosa or bladder mucosa. 2ree grafts li%e !ull Thickness Skin rafts or Split Thickness Skin rafts can be used for this purpose. Tissue Transfer Urethroplasty can be also be carried out in 2 stages if sufficient local tissue is not available for a Skin !lap "rocedure and local tissue factors are not suitable for a free graft.

What is the recovery period like followin# Urethroplasty? +ou will be instructed to stay in bed for the next 2 days you will be given pain %illers and antibiotics for the next few days to help you deal with the pain and ris% of infection. The indwelling catheter will be retained for 3 $ 4 days. #void performing strenuous activities li%e lifting something heavy playing sports or having sexual intercourse for at least 2 wee%s after Urethroplasty. +ou will be able to perform all your routine daily activities in about 2 wee%s time. +ou will be called in for follow up x$ray to ensure the results of Urethroplasty. What is the outcome of Urethroplasty? The success rate reported for Urethroplasty to treat urethral stricture is 5/ $ 6/7. Urethroplasty has optimal results in case of small strictures !2 cm or less" as well as large strictures i.e. more than 2 cm. $ % R % & % ' % ( % of Urethroplasty 8enefits of Urethroplasty Urethroplasty relieves pain and discomfort during voiding decrease in urine flow rate frequent urination due to urethral stricture. Urethroplasty can also reduce your ris% of getting orchitis prostatitis or recurrent urinary tract infection. &ecurrence of urethral stricture is rare after Urethroplasty. &is%s of Urethroplasty &ecurrence of urethral stricture Infection $ 9ound infection or urinary tract infection 2istula #llergic reaction to anesthesia #lternatives to Urethroplasty 'rethral -ilatation $ The goal of urethral dilatation is to stretch the scar tissue of the stricture without producing any additional scarring. This method may be effective in some very small strictures. 'rethral ,tents $ In this technique a short tube is placed inside the urethra that holds the strictured portion of the urethra open as it heals after surgery thus preventing the normal scar formation of healing from causing the stricture to recur. The lining of the urethra eventually covers the stent and it remains in place permanently. Internal Urethrotomy $ Internal 'rethrotomy also %nown as -irect )ision Internal 'rethrotomy !-)I'" is a surgical procedure used to treat urethral strictures !narrowing" due to scarring. Internal Urethrotomy can be categorized as &econstructive 'rology procedure where the normal anatomy and function of the urethra is restored by dilatation of the urethra. :ow or :ever 8esides having to bear the pain and discomfort during urinating urethral stricture can cause urinary tract infection and sometimes in infection of your testes stone

formation in bladder retrograde pressure on the %idney to cause %idney failure. 'rine may stop completely creating an emergency situation called acute urinary retention. Urethroplasty is a safe procedure used worldwide with good success rate. -ecision to have Urethroplasty ,everal techniques are available for the treatment of urethral stricture. +ou will be evaluated pre$operatively to be suitable for Urethroplasty procedure. -iscuss the procedure in detail with your physician to evaluate all the benefits and ris%s associated with Urethroplasty. Instructions for Care followin# Urethroplasty +ou have just undergone a major operation. The healing process ta%es time and we would li%e for you to observe the following instructions during your initial recovery. 9e have written this information for you to use as a reference during this initial healing phase. I'ITI&) "*ST+*" TR,&T-,'TS &'( I'STRUCTI*'S: "ain Control ;ur goal is to %eep you comfortable. +ou pain medication will be ordered as needed !<&:". This is not a medication that is given to you on a schedule. #s% your nurse for pain medications as you need them. +our nurse will assess you frequently for pain or discomfort. =owever please do not hesitate to as% for pain medication when you need it. &nti.iotics +ou will generally receive an antibiotic after surgery for 2> hours. +ou may be discharged home with a prescription for an antibiotic pill depending on your doctor?s recommendation. Incentive Spirometer /IS0 Purpose: To promote complete lung expansion and prevent respiratory complications. It is very important to use the incentive spirometer during the time before being up and about. Instructions ,eal the lips tightly around the mouthpiece inhale naturally and hold your breath for 3 to 4 seconds to achieve full lung expansion. @xhale and rest a few seconds. @ach time you inhale breath deeper trying to get the dis% in the column to a higher volume holding it there as long as you can. This should be done at least ./ times an hour while you are awa%e. -eep breathing exercises are also helpful. Ta%e a regular breath and hold to the count of five. @xhale completely. -o this about ./ times each hour while you are awa%e. Se1uential Compression (evices /SC(2s0 Purpose: ,*-?s enhance circulation by pumping the calf muscles. @nhancing circulation helps prevent the formation of blood clots. <lastic sleeves are wrapped around each leg. The sleeves are connected to a machine that inflates and deflates different segments of the sleeves to a preset pressure. This action mimics the action of your calf muscles during wal%ing. Instructions: The nurses will place the ,*- sleeves on both your legs in the operating room before surgery. These must remain in place as long as you are in bed after surgery. ;nce you are out of bed and wal%ing the ,*-?s are no longer needed. There are exercises called plantar

extensionAflexion that are important even when you are using ,*-?s as well as when you are up wal%ing again. "lantar ,3tension4!le3ion ,3ercises Instructions0 8egin by pointing your toes toward the bottom of the bed. Then point your toes up toward your face. &epeat this simple exercise at least .// times an hour while awa%e. &m.ulation /Walkin#0 +ou will be instructed to be up and about as much as you are able to tolerate. ,itting in the chair will be encouraged as well. The first few times that you get out of bed to wal% around someone will be with you to assist you. This is to ma%e sure that you are steady on your feet. +ou should then spend as much time out of bed as possible. #fter you are discharged from the hospital it is very important to continue to be up as much as possible. # rule of thumb is that you should be out of bed as much or more than you are in bed. Scrotal Support +ou may experience some swelling and rednessAbruising of the scrotum. This is normal. # towel roll may be placed under your scrotum to help %eep the swelling down. 9ear supportive underwearAbriefs or an athletic support. $athin# +ou may use the shower to bathe if you wish !even if you have a catheter in place". (ently wash the incision with soap and water rinse thoroughly and pat dry. This will be sufficient to %eep your incision clean dry and free of bacteria. -o not ta%e any tub bathsAsoa%s until your incision is completely healed !which should be in 3$> wee%s" or while you have a catheter. URI'&R5 C&TH,T,R/S0 +ou will have a 2oley catheter in your urethra after surgery. +ou may have a second catheter !suprapubic tube or ,< tube" that is placed in your bladder and comes out of the abdominal wall. The urethral 2oley catheter will remain in place for two to three wee%s after surgery. +ou will return to the 'rology clinic to have it removed. If you also have a suprapubic catheter the ,< tube will generally be removed after the urethral catheter. 9hether you have one or two catheters your catheter!s" should be anchored at all times with a catheter strap to your thigh or calf !or in some cases up to your abdomen". Instructions on how to do this are explained below and will be reviewed with you after surgery. If your catheter falls out6 contact the Urolo#y Resident on call at the University of -ichi#an Hospital immediately% He4she will instruct you as to what to do a.out havin# it replaced% -eatal 4 Catheter Care Purpose: To decrease the ris% of infection and scarring from the urethral 2oley catheter. Instructions: 'sing soap and water wash the around the meatus at the entry point of the 2oley catheter. <lace a small amount of bacitracin !triple antibiotic ointment" around the meatus at the entry point of the 2oley catheter. 9hile you are in the hospital and when you are home you should do this at least three times a day until the 2oley catheter is removed. Catheter )e# Strap 4 Holder

Purpose: To secure the catheter and prevent irritation. Instructions: <osition the leg band high around the thigh or on the calf with the product label on the outside of the leg. ,tretch the leg band in place and fasten )elcro tab. <lace the catheter or tubing over the green tab. Beave an ample loop in the catheter above leg band to avoid traction on the catheterC 9ith catheter or tubing in the desired position insert the narrow green )elcro tab over the catheter or tubing and through the square opening so that the )elcro tabs overlap. <ull the )elcro tabs in opposite directions and secure in place. To readjust raise either side of the tab adjust and refasten the tab. &eposition the leg band every > $ D hours to prevent pressure on your leg. This can be done by changing to the other leg or by raising or lowering the leg band. The leg band can be washed and dried without damage. Catheter (raina#e $a#s Purpose: To collect and store urine draining from the urinary catheter. Instructions: The nurse will help you with the initial set up. # connector is placed between the catheter and the tubing on the leg bag. ;nce the connector is attached it should not be removed. @ach leg bag comes with two straps. #ttach one strap to the top of the bag and one strap to the bottom of the bag. <ut the buttons of the leg bag strap through the slits on the bag. The buttons should face out to prevent a pressure point on your leg. <osition the leg bag with soft bac%ing against your s%in. #djust the straps until comfortable. @xcess strap may be trimmed with scissors. Ea%e sure that the outlet valve at the bottom of the bag is firmly closed before connecting it to your catheter. #ttach the leg bag to the end of the catheter by inserting the tapered connector snugly into the catheter port. -ribbling of urine from the catheter can be avoided by bending the catheter just below the end while you disconnect the tubing from the catheter. 8e careful to %eep the ends of the catheter and the tubing clean while connecting them so bacteria are not introduced into the system. To drain the leg bag open the clamp at the bottom of the bag and direct the urine into the toilet. The connector should be washed with soap and water after each disconnection and covered with the gray cap that is provided. &inse the leg bag with equal parts water F vinegar daily to %eep it bacteria free and reduce odor. +ou will also be given a large overnight bag li%e the one used in the hospital. :; E#TT@& 9=#T -&#I:#(@ ,+,T@E +;' ',@ &@E@E8@& T; G@@< T=@ -&#I:#(@ 8#( 8@B;9 T=@ B@)@B ;2 T=@ 8B#--@& ,; '&I:@ 9IBB 2B;9 -;9:9#&- I:T; IT. Catheter Irri#ation

Purpose: If the catheter is not draining freely you may need to irrigate !flush" it to remove the bloc%age. +ou do not need to irrigate your catheter unless it appears to be bloc%ed. Instructions: This applies to both urethral 2oley catheters and suprapubic catheters !,< tubes". +ou will need sterile water or saline for irrigation at home. The water or saline E',T be sterile. -; :;T ',@ T#< 9#T@&. Tap water often has bacteria in it that can cause infection if it is placed directly into your bladder. +our nurse will give you a bottle of sterile water or saline to ta%e home with you. 9ash your hands. -raw up >/ cc to D/ cc of sterile water or saline in the catheter tipped syringe provided. -isconnect the catheter from the drainage bag tubing. =old the tip of the catheter upright between the thumb and first finger. <lace the tip of the syringe into the catheter. (ently inject the sterile water or saline into the catheter. (ently withdraw the water or saline from the catheter with the syringe. 9atch for mucus or a small clot !that is what you want to see". This process may be repeated as needed until the catheter drains freely. #fter you finish irrigating o &inse the inside of the syringe with a small amount of the sterile water or saline. o 9ash the tip of the syringe with soap and hot water. o *leanse the tip of the syringe with alcohol and recap it. o ,tore your supplies in a clean place. If you notice a decrease in the amount of urine from your catheter it may need to be irrigated. If irrigation does not result in adequate urine drainage or if you have questions call the 'rology *linic and as% the nurse for further instruction. &ctivity +ou should continue wal%ing when you return home gradually increasing the amount of wal%ing you do each day. ,hort frequent wal%s of ./$.4 minutes are a good starting point !at least 3$> times a day". 9al%ing will help you rebuild strength. Ta%e planned rest periods during the day. The best gauge is your body and how you feel. +ou may wal% up and down stairs as soon as you return home but ta%e them slowly. #void heavy lifting !greater than 4 pounds" or strenuous activity for > wee%s after you are discharged. =eavy lifting can increase abdominal pressure which can put a strain on your incision. If you need to brace yourself to pic% something up then it is too heavy. 2ive pounds is equivalent to a large telephone boo% or a gallon of mil%. #void bending. This is tiring and also increases abdominal pressure. If you must pic% something up bend with your %nees !not at your waist".

 -o not resume sexual activity until you discuss it with your doctor at your first post$operative visit. +our doctor will let you %now when you can resume sexual activity typically after > wee%s. -o not drive for three to four wee%s or as directed by your doctor. # good rule is to not drive until you are pain free. This is because when you are having pain it will change the way you would react to something. +ou can be a passenger in the car but on long car trips ta%e frequent brea%s get out of the car and wal% around for a few minutes. -o not drive any motorized vehicle or sign any documents while ta%ing narcotic pain medication. The narcotic medication may cause changes in visual perception and impair your judgment. 777 & special note for men with a perineal incision a.out sittin# down 777 #s your doctor has explained it is necessary for you to change the way that you sit down after urethral reconstruction surgery. This pertains to men who have a perineal incision !an incision in between the anus and the scrotum". -o not sit directly on the incision. Instead sit with your weight shifted bac% onto your buttoc%s. +ou may use an air$filled donut soft cushion or other type of pillow to sit on especially for the first 3$> wee%s after surgery. +ou should pay attention to this for D months after surgery. -o not put any direct pressure on the incision for D months. It is recommended that you do not do any activity that requires you to straddle anything such as riding a bicycleAmotorcycleA#T) horsebac% riding etc. (iet +ou may return to your normal diet after surgery. -o not drin% alcohol while ta%ing narcotic pain medication. If there was a buccal mucosa graft harvested from your mouth0 o ,wish and spit one to two ounces !3/$D/mB" of Eagic Eouthwash or half strength hydrogen peroxide and saline solution four times a day until your mouth incision is completely healed. o In addition you may use other types of mouthwashArinse if you li%e. o +ou resume your usual oral care tooth brushing etc. the day after surgery. $owel Ha.its #void constipation. This will prevent unnecessary straining. To prevent constipation you can increase roughage in your diet drin% prune juice or orange juice ta%e mil% of magnesia or some other over the counter laxative. +ou will be prescribed *olace when you are discharged. This is a stool softener not a laxative. It is recommended that you drin% D$6 glasses of water a day to enhance the effectiveness of *olace. ,hould constipation become a problem that is not relieved call the 'rology *linic and as% the nurse for further instruction. *ther common concerns +ou may experience lea%age of urine or bloody fluid out of the end of the penis. The urine or blood may come out around and not through the urethral 2oley catheter. This can happen when one has a catheter. +ou may or may not also

experience pressure or pain in the bladder when the lea%age occurs. This may happen more commonly when you are having a bowel movement. *hec% to see if the catheter!s" is draining adequately. If not irrigate the catheter!s". The lea%age may occur intermittently while you have the catheter in place. This is not dangerous if the catheter is draining freely. If the lea%age is continuous if you have painful bladder spasms that are not going away or if you have questions call the 'rology *linic and as% the nurse for further instruction. The surgical procedures in existence during the 2/th century have been divided into two main types0 multi$stage reconstructive techniques and single stage reconstructive techniques. In multi$stage procedures a first operation was necessary to correct the chordee. 'rethroplasty only too% place afterwards necessitating one or more operations !=orton F -evine .H52". These procedures used during the major part of the last century and which used multiple s%in grafts I2>J as substitute material for the urethroplasty thus lengthening the time ta%en for the operation are not in use today I24J. In the field of surgery for hypospadias as stressed by 8abut !.HHD p. D>" 1the ideas are evolving and certain principles have been abandoned1. If some surgeons still ma%e use of multi$stage techniques these are no longer li%ely except in very severe cases !2erro Kaccara ,pagnoli F al. 2//2 ; (ershbaum ,toc% F =anna 2//2". The single stage procedures are surgical procedures which permit correction of chordee and urethroplasty in one and the same operation. These procedures mostly using penile s%in !s%in from the penis or prepuce" were introduced during the .HD/s then popularized around the .H6/s !Bottman .HH6". They have never ceased to be remodeled and subtly improved !8elman .HH5". In the last few years hypospadias repair has seen unprecedented evolution. &econstruction wor% originally purely functional has today combined with aesthetic repair wor% of increasing finesse !see for example =oebe%e -e Guyper et )an Bae%e 2//2". Hemophilia $: =emophilia due to deficiency of coagulation factor IL in the blood which results in prolonged oozing after minor and major injuries tooth extractions or surgery. There is renewed bleeding after the initial bleeding has stopped. The gene for hemophilia 8 gene is on the L chromosome so males are affected and females carry the gene. #bout ./7 of carrier females are at ris% for bleeding. @ach son of a female carrier stands a 4/ percent chance of receiving the gene and having hemophilia 8. Treatment is by blood products that introduce clotting factor IL and replace lost blood. =emophilia 8 is also called *hristmas disease !so$named for the first patient studied in detail with the disease". Hemophilia &: *lassic hemophilia due to profound deficiency of factor )III a blood factor necessary to normal clotting. The hemophilia # gene is on the L chromosome so females carry the gene. @ach son of a female carrier stands a 4/7 chance of receiving the gene and having hemophilia. Treatment is by blood products that introduce clotting factor and replace lost blood. =owever use of contaminated blood products exposed many

people with hemophilia to =I) infection in the .H6/s. =emophilia # has affected the &ussian royal house and other descendants of Mueen )ictoria.