Urethrectomy

Why is it done?

• As part of the treatment for aggressive localized Urothelial carcinoma of the bladder.
• T1G3 ?, > T2 disease.
• Primary Urethral disease with:
• Urothelial Carcinoma.
• Squamous cell carcinoma.
• Secondary metastatic disease to Urethra: Melanoma, Lung cancer, Breast cancer (all these are rare).
• Advanced disease may involve a penectomy.
• The procedure is part of the radical cystectomy, radical Cysto-prostatectomy or could be and adjunct later on when recurrences are found with surveillance.
• Part of a necrotic inflammatory condition ie: Fourniers Gangrene.

How is it done?

• This procedure is done under general anaesthetic.
• Legs are placed in a lithotomy position.
• A single incision is made on the midline raphe on the perineum (area between scrotum and anus). Sutures will be dissolvable.
• The Corpora Spongiosum with the urethra inside it is mobilized off the Corpora Cavernosa.
• Urethal Meatus is removed distal and glans is closed.
• Proximally the uretha is taken up to the sphincter and freed.
• You will have already had a diversion of the urine with an ileostomy or this will be done with your cystectomy part of the operation.
• A drain will be left for 24-48 hours to prevent the collection of serous fluids.
• A dressing is then applied, which should be removed after 72 hours.

What to expect after the procedure?

• Any anaesthetic has its risks and the anaesthetist will explain all such risks.
• If this is the only operation you have undergone, you will be sent home as soon as the drain is removed on D2 or D3.
• Swelling is a common complication.
• A haematoma (blood collection under the skin) may form and needs to be reviewed by Dr Schoeman as soon as possible. Bruising is normal.
• An infection of the wound may occur and requires immediate attention.
• Owing to the area of the surgery the wound should be kept clean and dry.
• DANGER SIGNS: A wound that swells immediately , fever, or puss. Please contact Dr Schoeman or the hospital immediately as this may occur in up to 15 % of all cases.

What next?

• The dressing should be kept dry for the initial 72 hours after surgery and then soaked in a bath until it comes off easily.
• The dressing may sometimes adhere to the wound causing slight bleeding on removal. Don’t panic, the bleeding will stop.
• On discharge a prescription may be issued for patients to collect.
• There will be signs of bruising for at least 10 days.
• The suture-line will be hard and indurated for at least 8-10 weeks.
• Please direct all further queries to Dr Schoeman’s Rooms.
• You should have a review appointment to discuss the pathology found and the need for further treatment (Chemo/Radiation Therapy).
• PLEASE CONTACT THE HOSPITAL DIRECT WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

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Urethrectomy