Urethral reconstruction is a surgical procedure used to repair damage or narrowing (stricture) of the urethra. When scar tissue blocks or restricts the urethra, it can lead to pain, difficulty urinating, recurrent infections, and potential damage to the urinary tract. Urethral reconstruction offers a long-term solution for restoring normal urinary function.
Why Urethral Reconstruction Is Performed
Urethral strictures may result from various causes, including:
- Trauma to the pelvis or perineum
- Previous surgeries or catheterization
- Infections, including sexually transmitted infections (STIs)
- Inflammatory conditions or radiation therapy
- Congenital abnormalities
Men are more commonly affected by urethral strictures than women, and in many cases, symptoms can worsen over time if not treated.
Symptoms of Urethral Stricture
Patients with urethral strictures may experience:
- Slow or weak urine stream
- Incomplete bladder emptying
- Straining to urinate
- Frequent urinary tract infections
- Dribbling or spraying of urine
- Blood in the urine (hematuria)
Types of Urethral Reconstruction
The type of reconstruction depends on the location, length, and severity of the stricture:
- Excision and Primary Anastomosis (EPA): The narrowed section of the urethra is removed, and the healthy ends are stitched back together. This is often used for short bulbar strictures.
- Substitution Urethroplasty: When the stricture is too long to simply remove, tissue grafts or flaps are used to reconstruct the urethra. Common graft sources include buccal mucosa (inner cheek lining) or skin grafts.
- Staged Urethroplasty: In complex or recurrent cases, a two-stage procedure may be needed. The first stage creates a new urethral channel using grafts, and the second stage completes the reconstruction.
What to Expect During Recovery
Urethral reconstruction is usually performed under general anesthesia. Most patients stay in the hospital for one night. A catheter is placed to allow the urethra to heal and is typically left in for 2-3 weeks. Follow-up imaging confirms proper healing before the catheter is removed.
Mild discomfort and swelling are expected after surgery, but most patients return to normal activities within a few weeks. Long-term results are generally excellent, with high success rates and low recurrence of strictures.
Next Steps
If you are experiencing symptoms of a urethral stricture or have a history of failed treatments like dilation or internal urethrotomy, urethral reconstruction may be the most effective long-term solution. A consultation with a urologist can help determine the best surgical approach for your condition.