Imagine that you have suffered a fractured pelvic bone due to an accident, perhaps a fall from a bike. Or you have been treated for prostate cancer. In such cases, sometimes the urethra in men can become damaged or narrowed. When it is difficult to urinate, the pain and discomfort that can occur when it is blocked cannot be explained. Today we are talking about a very important and special surgery that is needed at such times.
Simply put, what is Posterior Urethral Reconstruction?
Okay, let's start by explaining this simply. Urine, which collects in your bladder, comes out of your penis through a tube called the urethra. It's like a pipe coming out of a water tank.
This urethra also has parts. The short part, about one to two inches long, that connects to the bladder and passes through the prostate gland, is called the 'Posterior Urethra'. This is the beginning of the urethra.
Posterior Urethral Reconstruction is a surgical procedure that restores the integrity of the posterior urethra after damage, narrowing, or narrowing (urethral stricture). This means that the damaged part is repaired and urine flow is restored without obstruction.
Why is this surgery necessary?
There are two main reasons for having this surgery.
1. Accidental injuries: Especially major accidents that break the pelvic bone. In our country, such injuries are common due to motorcycle accidents, falls from heights, and crush injuries. In such accidents, this part of the urethra can be broken, bruised, and scarred. Over time, these scars can cause the urethra to narrow and make it impossible to urinate.
2. Treatment for Prostate Cancer: After surgery to remove the prostate gland (radical prostatectomy) or radiation therapy, the urethra may become narrowed due to the associated scarring.
When the urethra becomes narrowed in this way, the flow of urine can slow down, urine can leak out in small drops, or even become completely blocked. This is a very painful and dangerous condition.
How does the doctor decide if you need this surgery?
If you have these symptoms, the first thing your doctor will do is run a few tests to confirm the exact condition. To do this, they may perform one or more of the following tests:
- Retrograde Urethrogram: This uses a special liquid (contrast dye) and X-rays to see exactly where the blockage is in the urethra and how long it is .
- Voiding Cystourethrogram: This also uses contrast dye to look at how urine flows out of the bladder. This can help determine the extent of the blockage.
- Cystoscopy: In this, a thin camera-equipped tube (scope) is passed down the urethra to directly observe the inside of the urethra and bladder.
- MRI (Magnetic Resonance Imaging) Scan: In some special cases, an MRI scan may be performed if more in-depth information is needed.
The most important thing is that if this condition is caused by an accident, the doctors will wait until the other serious injuries in your body have healed. During that time, a tube can be inserted from the abdomen directly into the bladder to drain urine. We call it a Suprapubic Catheter .
How should you prepare before surgery?
Before surgery, you also need to prepare. Following these steps exactly is very important for the success of the surgery.
| What to prepare for | What to do |
|---|---|
| Blood thinners | If you are taking these types of medications, you should talk to your medical team and temporarily stop taking them a few days before surgery, as they advise. |
| Food and drink before surgery | Do not eat or drink anything after midnight on the day of surgery. |
| Morning medications | The doctor only allows you to take the medicine that has been approved by him in the morning with a sip of water. |
| Antibiotics | To prevent infection, the doctor may prescribe antibiotics to start a day before the surgery. |
How does the surgery actually happen?
This surgery is performed under general anesthesia, which means you won't feel anything, you'll be asleep.
The most common procedure used by surgeons is called Anastomotic Urethroplasty . This is a very simple procedure.
The injured, scarred, or narrowed portion of the urethra is cut out and removed, and the two healthy ends are sewn back together. It's like removing a broken piece of pipe and reconnecting the two remaining good pieces.
But, imagine that after removing the scar tissue, the gap between the two remaining healthy ends is a bit too large, making it difficult to sew them together. What do you do if that happens?
In such cases, the surgeon takes a small piece of tissue from another part of your body and uses it to fill the gap. Most often, this is the tissue inside your cheek (buccal mucosa) . Taking a small piece from inside your mouth is not very painful. It's like a little pain when you get a cut on your cheek. Also, wounds inside your mouth heal very quickly, usually within a week.
What happens after the surgery and what are the risks?
After the surgery, you will be monitored in the hospital for about 24 hours. A small, soft catheter will be inserted through your penis into your bladder until the stitches heal, which will take about 3-4 weeks. This is a bit uncomfortable, but it is essential for the repair to heal properly. After 3-4 weeks, an X-ray will be taken to check if the repair has healed, and the catheter will be removed.
Like any surgery, this one has some minor risks.
- Bleeding
- Infections
- Recurrent stricture
Urinary incontinence is a risk and is very rare if surgery is performed. However, the risk may be slightly increased if surgery is performed after cancer treatment.
Another important issue is erectile dysfunction (ED) . Some men may have had this condition before this surgery, after a pelvic fracture or cancer treatment. This surgery will not cure ED. It may require other treatments later. Talk to your doctor about this openly.
Surgery success and recovery
This is the best news. This surgery has a very high success rate. The results are very good, especially when performed by an experienced surgeon.
- The success rate of surgery for injuries sustained in an accident is between 92% - 97% .
- The success rate of surgery after cancer treatment is between 70% - 85% .
Back to normal life...
- Driving: You can start driving if you are not using painkillers and after the catheter tube is removed.
- Returning to work: Most people return to work after the catheter is removed, but only light duty work is recommended for 6-8 weeks .
- Exercise: Walking is fine after surgery, but avoid strenuous activities like lifting weights or playing golf for 6-8 weeks .
- Sexual activity: You can resume sexual activity 8 weeks after surgery.
Take-Home Message
- Posterior Urethral Reconstruction is a specialized surgery performed for men whose urethra is narrowed due to pelvic injuries or prostate cancer treatment.
- The goal of this surgery is to repair the damaged section of the urethra and restore urine flow.
- This is a surgery that usually has a very high success rate, so there is no need to be afraid.
- It is very important to follow your doctor's instructions carefully before and after surgery, especially regarding the catheter and activity restrictions.
- Never hesitate to talk openly and honestly with your doctor about any issues you may be experiencing, such as urinary incontinence or sexual dysfunction. Getting the right information and support is an important part of the healing process.
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