Two Stage Urethraplasty

Why is it done?

• To treat urethral strictures (narrowing) caused by trauma, infection, malignancy, etc, longer than 2 cm in length

Pre-requirements

• An informed consent is required from the patient.
• Patients may not eat or drink from midnight the previous evening.
• Patients are to refrain from smoking before the procedure.
• Patients allergic to IODINE / CHLORHEXIDINE should clearly state this at the Pre-admission clinic as well as to theatre staff and Dr Schoeman.
• Any anti-coagulants such as Warfarin or Aspirin must be stopped 7 days prior to surgery. Clexane injections may be substituted.
• Patients with cardiac illnesses require a cardiologist / physician’s report.
• A chest X-ray is required for patients with lung disease.
• Pre-op blood tests are required 4 days prior to surgery.
• The whole scrotal area is shaved once hospitalized.
• Be prepared for an overnight stay.

How is it done?

• This procedure is done under general anaesthetic.
• Legs are placed in a lithotomy position.
• Depending on where the stricture is, A single incision is made on the midline raphe of the penis or perineum (area between scrotum and anus).
• The affected urethra is exposed and opened on the dorsal aspect (side adjacent to the penile corpora).
• A graft could be harvested from the inside of your mouth, or alternately from foreskin or penile skin (hairless).
• This is then incorporated into the sick urethra to open the defect.
• A long-term catheter will be inserted for 10-14 days.
• A dressing is then applied, which should be removed after 72 hours.
• A local anaesthetic is injected into the wound, thus giving post-operative pain relief for the next 4-6 hours.
• A drain may also be left for 24-48 hours to prevent the collection of serous fluids.

What to expect after the procedure?

• Any anaesthetic has its risks and the anaesthetist will explain all such risks.
• Bleeding 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.
• You will be sent home with an indwelling catheter for 10-14 days.
• An infection of the wound may occur and requires immediate attention.
• Erectile dysfunction (15%) may occur.
• Re-stricturing (20-30%) may occur.
• Owing to the area of the surgery the wound should be kept clean and dry.
• DANGER SIGNS: A scrotum that swells immediately to the size of a football, 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.
• Arrangements will be made for the removal of the catheter after 10-14 days.
• A urinating Urethragram will be arranged with radiology within 6 weeks to determine the final result of the surgery.
• 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.
• PLEASE CONTACT THE HOSPITAL DIRECT WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

Download Information Sheet

Two-Stage Urethraplasty