Urethroplasty

Many men who contact us regarding possibly undergoing a urethroplasty have questions about the potential cost of a urethroplasty and are also curious about what urethroplasty recovery is like. While these are definitely reasonable questions, it is very difficult to provide a concrete answer because it all depends on the circumstances surrounding the procedure. While some surgeries have just one definitive technique that will effectively resolve any and all issues, there are many operations that can be performed to cure urethral stricture disease. Which surgery will best repair the urethral stricture depends on the length and location of the stricture, as well as several other factors, especially if there has been failed treatment in the past. Many patients are not sure how long or exactly where their stricture is because they have not had a proper diagnostic evaluation prior to failed treatment at a different facility. That is why the first step when we see a new patient is always to make sure we accurately define the stricture.

After the completion of a thorough diagnostic evaluation, we will review all treatment options. If the best method for urethral stricture repair is urethroplasty surgery, we can then review the details and what is involved with that particular procedure. The following is a basic overview of some of the most common urethroplasty options. Additional information related to particular urethroplasty options can be found in separate sections, such as the pages on bulbar strictures, pelvic fracture urethral injuries, lichen sclerosus, and recurrent and complex strictures.

For shorter urethral strictures, treatment may involve surgery to remove the impacted segment of the urethra and re-attach the two normal ends. The urethra has some elasticity and ability to stretch, so if a short segment is removed, the ends can be brought together without any tension. This urethroplasty method is called excision and primary anastomosis, but also may be referred to as an anastomotic urethroplasty. This procedure is best suited for short strictures that are located deep in the urethra, more towards the prostate in the bulbar or membranous urethra. More information about anastomotic urethroplasty can be found in the sections on bulbar strictures and pelvic fracture urethral injuries.

While the urethra has the ability to stretch, this elasticity has limits. When the stricture is longer and a larger section of the urethra needs to be removed, the ends simply can’t be brought together. That is why it is so essential to first accurately define the length of the stricture, so that before beginning the surgery the urologist knows if the stricture is short enough to be amenable to anastomotic urethroplasty. If the stricture is too long and excision and primary anastomosis is not possible, tissue can be transferred to the urethra to augment and widen the narrow segment to a normal size. The area of narrowing or stenosis in the urethra is cut lengthwise and split completely open, so the tube becomes a strip. Then, tissue patch is added so that when the urethra is stitched back into a tube it will be wider. A variety of different types of tissue can be used to augment the urethra and make it wider, including penile skin and a graft of buccal mucosa (the skin inside the cheek).

When the above procedures are not an option, there are a few alternative urethral stricture repair methods. One such method is a two-stage repair where first a skin graft is placed along the undersurface of the penis, and later rolled into a new urethra (neo-urethra) during a second surgery. Ultimately, the urologist must make a choice as to which urethroplasty technique is best for each individual patient. A variety of factors go into the choice of repair technique, including the length and location of the stricture, the availability of local tissue, and other factors.