Do you also have a little difficulty urinating? Does the urethra feel weak and constricted? Do you sometimes feel like you have not completely emptied your bladder even after urinating? This could be due to a blockage in your urethra. This is especially true if you have recently had an accident, especially one that affects the pelvic area, or if you have been treated for prostate cancer. So today we are talking about a special surgery that is a good solution to this. That is the Posterior Urethral Reconstruction surgery.
Simply put, what is Posterior Urethral Reconstruction?
To understand this, let's first learn a little about these parts of our body. You know that the urethra is the tube that carries urine and semen from our bladder out of the body. This urethra also has several parts.
Posterior Urethra refers to the back of the urethra, that is, the part that is inside the body. To be precise, we refer to the small part of the urethra, about one or two inches long, that runs from the bottom of the bladder, through the prostate gland, and through the muscles of the pelvic floor.
So, Posterior Urethral Reconstruction is a surgery to restore the posterior part of the urethra that has been damaged, blocked, or narrowed for some reason.
In what cases is this surgery necessary?
The main reason for this surgery is often a narrowing or blockage of the urethra (Urethral Stricture) . Just as dirt builds up inside a water pipe and reduces the flow of water, when scar tissue forms inside the urethra and narrows it, it becomes difficult to pass urine. Sometimes the urethra can become very narrow, or it can stop completely.
There are several main reasons why the urethra becomes blocked in this way.
| Reason | Description and examples |
|---|---|
| Serious injuries like pelvic fractures | A severe injury to the pelvic area (hip bone) can damage the urethra. For example:
|
| Prostate Cancer Treatments | This condition can also occur after some treatments for prostate cancer. That is:
|
What tests are done before surgery?
Before a doctor decides to perform this surgery, they will perform several tests to determine exactly how blocked your urethra is and the extent of the damage.
- Retrograde Urethrogram: A special liquid is injected into the urethra and X-ray images are taken.
- Voiding Cystourethrogram: A tube is inserted into the bladder, filled with liquid, and an X-ray is taken while you urinate.
- Cystoscopy: A very thin tube with a camera attached is passed down the urethra to examine the inside.
- MRI Scan: Sometimes an MRI scan may be done to get a clearer picture of this area.
The most important thing is that after an accident, doctors first wait for the injuries to stabilize. During that time, a small tube is inserted through the skin of the abdomen into the bladder to drain urine. It is called a suprapubic catheter .
How to prepare for surgery?
It is imperative that you follow the doctor's instructions for your safety before surgery.
| What to do | Why is that? |
|---|---|
| Tell us about any allergies you have. | Avoid allergic reactions to medications given during surgery. |
| Tell your doctor about all the medications you take (including vitamins and Ayurvedic medicines). | Some medications can affect the surgery. |
| If you are taking blood thinners, temporarily stop taking them as directed by your doctor. | Stop unnecessary bleeding during surgery. |
| Stop eating and drinking 8-12 hours before surgery. | If you have food in your stomach while you're unconscious, or if you vomit, it can go into your windpipe. That's dangerous. That's why it's called that. |
You may also be given an antibiotic starting the day before the surgery to prevent infection.
How is the surgery done?
First, the anesthesiologist will put you under general anesthesia . This means you will be in a deep sleep. You will not feel any pain or anything until the surgery is over.
The urologist then begins the surgery. Anastomotic Urethroplasty is the most common method used for blockages after an accident.
Imagine, this is what happens:
1. First, a small incision is made in the area between your scrotum and anus (perineum).
2. Then, the scarred tissue that is stuck in the urethra is completely cut out and removed.
3. Finally, the two ends of the remaining healthy urethra are brought together again, and sewn together very delicately.
Imagine, sometimes when the scarred part is removed, the gap between the two remaining healthy parts can be a little wider. In such cases, doctors do something very strange. They 'borrow' a small piece of tissue from the inside of your own cheek or lip (buccal mucosa) , fill that gap, and rebuild the urethra.
This surgery can usually take between three and six hours .
What happens after the surgery?
Once the surgery is complete, the incision will be stitched up, cleaned, and bandaged. Additionally, a Foley catheter will be inserted through your penis into your bladder to help drain urine. This is to help keep urine flowing smoothly until the urethra heals. Don't worry, this is temporary.
A small surgical drain may be placed near the wound to help it heal. This is usually removed before you leave the hospital.
As the effects of the sleep-inducing medication wear off, you will gradually regain consciousness. You will feel a little sluggish at first. Once you regain consciousness, you will be given pain relievers to control the pain.
Once the doctors decide that your condition is good, you can go home. However, you may have to stay in the hospital for a day or so.
You will be given follow-up appointments with the doctor over the next few months. At that time, tests such as X-rays and cystoscopy may be repeated to see if the wound is healing properly.
The Foley catheter will be in place for 3-4 weeks, and your urine will pass through it. After it is removed, you should be able to urinate as easily as you did before the blockage.
Benefits, success and risks
Like any surgery, this one has benefits as well as some minor risks.
| Section | Description |
|---|---|
| Benefits | The discomfort caused by urinary retention is gone, and you can urinate without pain or straining. The frequency of urinary tract infections (UTIs) is reduced. It is also very good for kidney health, as the bladder empties well. |
| Success Rate | This surgery is very successful . Studies show that surgery after a pelvic injury is 92% to 97% successful. After prostate cancer treatment, the success rate is 70% to 85% . |
| Side Effects & Risks |
The risk of urinary incontinence is low, but it is slightly higher after cancer treatment. Erectile dysfunction (ED) can often be caused by the initial injury or cancer treatment. This surgery will not cure the condition, and may require separate treatment. |
Recovery time and things to be aware of
Your dedication to recovery after surgery is also very important.
Pain
Many people may feel some pain, but it can be well controlled with the painkillers prescribed by the doctor.
Activities
- Avoid driving and sitting for long periods of time until the catheter is removed (3-4 weeks).
- Walking and climbing stairs are no problem.
- Do not lift weights heavier than 9 kg (20 lbs).
- Avoid running, squatting, leg extension exercises, and sports that involve rotating the hip area (such as golf) for a month or two.
Sexual activity
Completely abstain from sex or masturbation for at least 8 weeks .
Back to work/school
If you work in an office, you can start in a week or two. But if you have a physically demanding job, you will have to wait at least 6-8 weeks.
Any opportunity to meet a doctor
If you experience any of the following symptoms after going home after surgery, call your doctor immediately.
| Risk symptoms - inform the doctor immediately! | |
|---|---|
| - Inability to urinate. | - Blood or blood clots in the urine even a week after surgery. |
| - Urine coming out of the catheter is very slow. | - Pus-like fluid oozing from the wound. |
| - Signs of infection such as fever, chills, and headache. | - Increased pain or pain that does not subside despite taking medication. |
| - Swelling of the surgical area. | |
It's hard enough to deal with something like an accident or cancer. It's normal to feel very anxious when another problem like a urethral stricture comes along. But the good news is that Posterior Urethral Reconstruction is a very successful treatment. With this surgery, you can urinate without any difficulty again.
Take-Home Message
- Posterior Urethral Reconstruction is a very successful surgery for strictures in the posterior part of the urethra.
- This condition most often occurs after serious accidents or prostate cancer treatment.
- It's normal to feel scared and anxious about surgery, but the main goal is to improve your quality of life.
- During the recovery period, it is essential to follow the doctor's instructions exactly for a speedy recovery.
- If you have any difficulty urinating or other symptoms, never delay talking to a doctor about it.
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