Best Urethroplasty Surgery in Delhi, India

The urethra is a very thin, fibromuscular tube that lets urine leave the bladder and external parts of the body. In the case of females, it is about 4 cm in length, whereas, in males, it is about 20 cm in length.

Urethroplasty is a surgical procedure used to repair or reconstruct the urethra. It is commonly used to treat strictures, which are areas of narrowing or blockage in the urethra. Urethroplasty is performed on the urethra to repair or replace it because of scar tissue formation. After removing the scar tissue, the surgeon joins both ends of the urethra by taking tissues from the surrounding areas. The main aim of this procedure is to rebuild the blocked part of the urethra.

The Male Urethra Consists Of 4 Parts:

• Prostatic part: It goes down through the prostate and, at times, can dilate accordingly to change in size.
• Membranous part: It is present between the prostate and the beginning of the penis.
• Bulbar part: It navigates through the penis to end at the external urethral orifice. This is the longest part of the urethra.
• Penile part- The portion of the urethra which traverses the length of the penis till the bulbar urethra.

Common conditions affecting the urethra are as follows:

• Urethral strictures: Due to scarring of tissues, the urethra gets narrow, resulting in inflammation, followed by infection, pain while passing urine or, in some cases, difficulty while emptying the bladder.
• Urinary Tract Infections: Infections taking place in the urinary tract, along with the urethra, are the most common site of infection. At times, the infection may also be attributed to catheter usage.
• Urethral injury: These comprise sharp trauma injuries and gunshot injuries resulting in the dripping of urine near surrounding tissues and bruises.
• Urethritis: It refers to inflammation of the urethra caused due to gonorrhoea or other sexually transmitted infections.
• Genitourinary vaginal fistulas: These occur because of the opening up of holes between the urinary system and vagina or uterus.
• Urethral cancer 
• Congenital conditions of the urethra like epispadias or hypospadias.

Where are the Tissues Taken From for a Urethroplasty?

Body tissues that are used most often to fix a urethra are taken from:

⮚ Mouth: From the lining of the cheek or back of the lips. This is called the buccal mucosa.

⮚ Genitals: The surgeon might use the skin from there. If the patient has undergone gender affirmation surgery, the surgeon uses skin from the vagina or labia.

⮚ Rectum: Here, the tissues are taken via a procedure performed through the anus for surgery.

Procedure

Before the Procedure

• Confirmation of the length and location of blockage at the urethra is made through Retrograde Urethrogram and MCU and Cystoscopy. Both of these are minimally invasive diagnostic procedures performed mostly on male patients.
• Cystoscopy is a form of endoscopy of the urinary bladder. A thin camera is inserted into the urethra and passed into the bladder.
• A urethrogram comprises an X-ray contrast agent gently moved into the urethra. Afterwards, x-ray scans are taken with the dye to assess the urethra clearly.

Before the day of the procedure, the patient is advised to do the following:

• Stop consumption of blood thinners
• Avoid smoking and drinking
• Avoid consumption of meals after midnight before the procedure.
• Insertion of a suprapubic catheter before the procedure- if needed
• Removal of all kinds of jewellery, including rings
• Avoid constipation
• Wear loose clothing
• Maintain healthy diet
• Avoid holding urine for a prolonged period of time
• Maintaining a regular physical exercise routine

During the Procedure

The estimated time required to complete this surgery usually depends on the amount of repair work to be done. In cases where a repair is made involving joining two ends of the urethra together, it takes comparatively less time than using grafts or flaps. In some cases where the entire urethra is involved, multiple pieces of tissue are required to rebuild the urethra.

The procedure involves making an incision near the scrotum or perineum, identifying the location of the blockage, and removing or rebuilding the obstructed area.

1) Making the incision- The surgeon begins by making an incision near the scrotum, which is the most common approach for the incision. Alternatively, in some cases, the incision can also be made between the scrotum and anus, i.e., perineum. The location of the incision is determined by the location of the obstruction.

2) Identifying and removing the blockage: After the incision is made, the surgeon identifies the location of the blockage. If the obstruction is shorter in length, it can be removed by the surgeon. However, if the obstruction is longer than usual and is located in the penile urethra, the surgeon may need to take tissues from the mouth, genital, or rectal area to compensate for the incised tissue from the urethra.

3) Rebuilding the urethra: Once the obstruction is removed, the surgeon may need to rebuild the urethra. This involves using tissue grafts from the patient's own body or a donor to create a new section of the urethra. The grafts are carefully sewn into place, and the new section of the urethra is carefully shaped to ensure that it functions properly.

4) Suturing the incision: After the urethra has been repaired or reconstructed, the incision site is sutured, and a small drain is kept in place for a day or so. The catheter is kept in place to provide adequate healing time to the urethra. The sutures are typically removed after a few weeks, depending on the extent of the surgery and the patient's recovery.

After the Procedure

• Patients may need to stay on the hospital premises for a day or two, depending on the type of procedure performed.
• The patient is prescribed antibiotics, pain medications and medications to prevent bladder spasms. Apart from these, additional medications are given to prevent erections. 
• If tissues are taken from the inside of the mouth to reconstruct the urethra, oral mouthwash is recommended. 
• Regular follow-ups are advised two to three weeks after the procedure.

Success Rate

The main and foremost advantage of urethroplasty is that this procedure is the best possible way to treat urethral strictures so that there is a free flow of urine. The success rate of this procedure varies between 80% to 90%.

Risks

Just like any other procedure, this procedure also comes with possible risks or complications. Commonly seen risks associated with this procedure are as follows:

• Catheter leakage or blockage
• Urine tract infection
• An additional procedure, like the internal cutting procedure for removing scar tissue, is required in some cases apart from urethroplasty
• Pain in the scrotum or perineum
• Erectile dysfunction
• Leakage of urine or semen
• Nerve injury to extremities.

Precautions

• Avoid squatting position and spreading legs apart
• Avoid driving
• Avoid sitting for prolonged periods while the catheter is still in place
• After the removal of the catheter, avoid sexual intercourse and masturbation for over six weeks after surgery.
• Refrain from travelling for a period of two to three weeks after this procedure

After the successful completion of this procedure, it is advised to consult the doctor if the patient presents with the following conditions:

• Open incision
• The patient has sudden, unexpected, and tremendous pain
• Fever
• Formation of pus
• Blocked catheter
• Oozing of blood

Urethroplasty is a complex procedure that requires skilled surgeons and advanced medical equipment. With proper care and follow-up, patients can fully recover from this surgery and regain normal urinary function. Urethroplasty is a highly effective treatment for urethral strictures and other urethral conditions.

Review 

Reviewed By Dr Rohit Kaushal, Senior Consultant Urology, Kidney Transplant on 12 June 2024