Dr Jo Schoeman
Urological Surgeon

        

Two Stage Urethraplasty

Product Summary: AMA rates

Repair of long segment urethral strictures in 2 stages

Item Number: 37345, 105; 37348, 105

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.

Two Stage Urethraplasty Two Stage Urethraplasty (312 KB)