Urethrectomy

Removal of urethra. Usually in adjunct to a radical cystectomy. Occasionally done some time after a cystectomy where recurrences occur in urethra.

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.

This procedure is done under general anesthetic.
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.
Urethral meatus is removed distal and glans is closed.
Proximally the urethra 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.

Any anesthetic has its risks, and the anesthetist 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 hematoma (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.

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 CONTACT THE HOSPITAL DIRECTLY WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

Download Information Sheet

Wes Urethrectomy