What does the procedure involve?
Open repair of the urethra for a stricture close to the bladder
What are the alternatives to the procedure?
Observation, optical urethrotomy, repeated stretching using metal/plastic dilators
What should I expect before the procedure?
You will usually be admitted on the day of surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, and your named nurse.
You will be asked not to eat or drink for 6 hours before surgery.
You will be given an injection under the skin of a drug (tinzaparin) that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the leg veins.
What happens during the procedure?
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 may be inserted and possibly 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 sometimes does not require any stitches.
What happens immediately after the procedure?
If a graft has been taken from the cheek lining, antiseptic and anaesthetic mouthwash will be used regularly and wide opening of the mouth is encouraged. You are allowed to eat and drink straight after the operation but it may be a few days before you are fully comfortable with doing that. The average hospital stay is 3 to 4 days. You will go home with a catheter in place and this will be left in place for 2-3 weeks (see below).
Are there any side-effects?
Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.
You may experience discomfort in the mouth and restricted jaw opening if a graft has been taken from the cheek lining. You may develop a recurrent stricture requiring further surgery or other treatment – this may affect up to 20% individuals.
You may experience loss of or altered erections as a result of surgery to the urethra. Men can experience dribbling of urine post-operatively due to “bagginess” of the graft
What should I expect when I get home?
When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation.
If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.
There may be some discomfort from the catheter and physical activity will generally be restricted for 2-3 weeks.
Jaw movements may be restricted if a graft has been taken from the cheek lining and wide opening of the mouth is encouraged.
What else should I look out for?
Any increasing pain, wound discharge or swelling should be reported to your GP immediately.
Are there any other important points?
Before the catheter is removed, an X-ray (urethrogram) will be arranged alongside the catheter in the penis, approximately 3 weeks after your operation, to ensure that the area has healed. If the X-ray is satisfactory, the catheter in the penis will be removed.
If healing is not complete on the X-ray, the catheters will need to remain in place and a further X-ray will be arranged after another 2 weeks. After catheter removal, you will be followed up in the outpatient clinic after 12 weeks.
