Urethroplasty in Delhi (South Delhi)


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Urethroplasty is a surgery performed by Urologist that helps in reconstructing urethra, so that problems related to urethral strictures diseases can be cured by removing the segments that are involved and again attaching both the normal ends. Through this procedure the scarred tissues in the urine channel from the bladder to the penis are repaired. There are several types of Urethroplasty surgeries that depend upon the causes, location as well as stricture length. Most of these surgeries are completed within 3 to 6 hours. This surgery involves incision near the stricture area like penis, perineum or scrotum. Urethroplasty surgery is suited best for short strictures. When the urethra is unrepairable with the help of surgery the tissues can be transferred and augmented using the penile skin or buccal mucosa grafts, so that the normal segment can be widened to normal calibre or with the help of the two stage repairs. The skin graft is placed under the surface of the penis and transform into the new urethra. These repairs completely depend upon person to person, tissue availability, location as well as the length of the stricture.

Depending upon the type of urethroplasty surgery performed, the urethral catheter is left as it is, for almost a month. Evaluation of the surgical area is done while the x-ray is taken. If the area of surgery is completely healed the catheter is removed safely and gently.





Why this procedure is required?

Urethroplasty is a procedure that is performed to repair injuries, defects that are present within the urethra or even urethral strictures. Urethral strictures in a person can be caused because of various reasons like:

  • Infection
  • Trauma
  • Hypospadias
  • Dermatologic diseases
  • Iatrogenic treatment

People who have been involved in accidents or had suffered pelvic injuries require such procedure to be performed. A person having a scared tissue in the urinary channel may result in slowing the stream of urine, blocking urine from coming out or even causing discomfort. To get rid of these issues, this procedure is required. Balanitis Xerotica Obliterans (BXO) is a reason for some type of scar formation that affects the penis.

Symptoms

Symptoms of urethral stricture that requires urethroplasty surgery to be performed so that all the symptoms can be cured and the sexual functionalities can also be retained. The symptoms that a person experiences during this period are as follows:

  • Urinary tract infection
  • Infection in bladder
  • Feel pain at the time of urinating
  • Difficulty in emptying the bladder
  • Weaken or tiny stream of urine
  • Dribbling
  • Urinary Incontinence
  • Complete blockage
  • Decrease in the force of ejaculation

Types of Urethroplasty

There are various types of urethroplasty surgery that helps in repairing the walls of the urethra amongst which four of them are commonly used.


  • Anastomitoc Urethroplasty
  • Buccal mucosal on lay graft
  • Scrotal or penile island flap (graft)
  • Johansen's urethroplasty.

The type of urethroplasty that is performed on patients depends upon several factors such as:

  • The physical condition of a patient
  • Condition of urethra i.e. not affected by stricture
  • Degree of defect
  • Multiple number of misaligned strictures
  • In accordance to the prostate gland, ejaculatory duct as well as the urinary sphincter’s defect in anatomical positioning.
  • Present condition of the urethral wall
  • Condition of the urethral wall
  • Complications or scars that appeared as a result of previous surgeries or stent
  • Availability of tissue from buccal cavity for the buccal mucosa that is the most preferred procedure
  • The second best type of urethroplasty procedure is Scrotal or penile island flap that is possible with the availability of auto graft tissue from the penis as well as the scrotum
  • Last but not the least the expertise and specialization of the surgeon is very important

More than one type of procedure may be applied to some of the complex cases

Urethroplasty is not a minor operation as sometimes it may even take more than eight hours to complete. The operation that takes shorter duration of time may even allow 20% to 30% patient to be back home soon on that same day. On an average the patient has to spend almost 3 to 10 days max in a hospital, depending upon the complexity. The hospital stay of a patient depends completely on the condition of the patient, recovery phase, after effect of sedations, medications as well as the post surgical complications.


How is Urethroplasty surgery done?

Urethroplasty procedure is a reconstructive surgery that is performed for the treatment of urethral strictures. This treatment is especially for those people who are unaffected by endoscopic management. There are very few specialist/urologist who are skilled in performing these procedures because of some medical technical issues. There are two general types of urethroplasty treatment procedure:


  • Primary Anastamotic Repairs:- During this primary phase of the treatment, repairs comprises of the removal of stricture and reconnecting the urethra’s healthy ends.
  • Substitution Repairs:- This substitutive phase involves the technique of tissue transfer specifically in which the inner cheek tissue or genital skin tissue is involved that are used for stricture so that their calibre can be enhanced.

The Anastamotic Repairs are very common and most preferred amongst the urologist and the patients as they are not very complex and they are even highly successful. Substitution repairs are needed at times in certain situations when the stricture is too lengthy. The success of the Substitution Repairs is approximately higher than 80%. There are certain cases when the combo of both primary and substitutive repairs is required for the great results for the multiple and lengthy strictures.

For performing the surgery the patient is sedated using general anaesthesia or spinal anaesthesia because the procedure requires an incision. For 7 to 12 days the patient will have to move with catheter depending upon the type of urethroplasty.


Expectation after Treatment

The patient will be monitored constantly by the team of specialist for recording the pulse oximetry, ECG, temperature of the body and Blood Pressure till the patient is discharged to the post operative recovery room. After the treatment the patient usually experiences pain after the effect of anaesthesia slows down. But this pain cannot be considered as worse, but still it is uncomfortable for sure. The doctor’s gives pain killers for reducing discomfort. Very few patients do not feel the pain after the completion of treatment. If the particular patient will be discharged on the same day, then he will be instructed to keep the catheter clean, changing the dressing, methods of monitoring for infections and understanding when the catheter is blocked and how to empty its drainage system.

A catheter is inserted in the penis for 7 to 12 days, so that the area of incision can heal properly and stay dry. This tube, i.e. the catheter must be kept clean and properly attached with tapes to the skin so that movement of the tube can be restricted. The patient is also instructed to apply antibiotic ointment at the tip of the penis so that the catheter does not stick to it.

The doctor will also prescribe antibiotics, urinary antispasmodic, pain killer along with anti-infective agents. Just after the operation, for the first two days the patient will be advised to take complete bed rest and eat fibrous food and drink plenty of water so that the patient do not push hard while passing the stool. He will be advised to use docusate sodium for softening the stool quality, so that straining can be easily avoided.

After resting for the first two days, the patient will be advised to resume his physical activity slowly and steadily without being harsh on them self. It is important that the patient keeps themselves properly hydrated by drinking lots of fluids before as well as after the recovering phase. After approximately 7 to 14 days, retrograde urethrogram is scheduled by the surgeon for removing the suprapubic or catheter.

Before a day or two of the improvement the patient will start experiencing or noticing swelling and bruising of the scrotum. The patient may also feel discomfort and pain around the area of incision. The urine in the bag of the catheter will appear either discolored or at the time you will even notice it having blood stain. For the treatment, if the surgeon has opted for taking the graft from the inside of cheeks i.e. the buccal mucosal graft, then for at least two days after the treatment the patient will have swollen cheeks.


After Care

After the treatment procedure the stay of patients in the hospital depends completely on his health and response towards the medication. Usually the stay does not even exceed for a week. The patient may experience discomfort, pain or swelling in the scrotum or penis. Swelling in cheeks can also be seen for at least two days after the treatment in case of buccal mucosa graft. The doctor prescribes painkiller to help you deal with the pain.

Patients that undergo buccal mucosal graft are advised to have soft diet. Once the patient is discharged from the hospital, he is advised to take things as slow as possible and take complete rest. They have been advised to remain inactive for few months, and then step by step increase the activity level. This means that for 2-3 months the patient must avoid any type of weight lifting, exercises and strenuous and stressful work load. Catheters stay with the patient for almost 7 to 10 days. During follow up if the doctor analyzes and finds out that the urethra is healed properly, then he/she may remove the catheter. Follow up schedules depend upon the analysis made from the reports. It is very important because urethral stricture may recur if not taken care of.


Precautions after treatment

The patient is advised to take complete bed rest during the initial days and be inactive for about 3 months so that straining can be avoided. Later on, with safety they must resume the normal routine, but in a slow and steady manner. During the recovering phase, the prescribed medicines ointments and instructions must be followed without fail. The patient must take fibrous food and drink lots of fluid so that the passing stool does not cause tension. Patients are advised not to push hard while passing the stool to avoid mishaps.

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