The best solution for urinary tract obstruction: Let's learn about Urethroplasty surgery in simple terms

Do you also have a little difficulty urinating? Is the urine stream very weak and slow? Or does it drip? Do you sometimes feel like there is still urine after you finish urinating? If you have any of these symptoms, the reason may be a blockage or narrowing of your urethra. This is medically known as `(Urethral Stricture)`. So today we are going to talk about the most successful and permanent solution to this problem. That is the surgery called `Urethroplasty`.

Simply put, what is Urethroplasty?

To understand this, let's first take a look at how our urinary system works. Urine is produced in our body in the kidneys. Then, that urine collects in the urinary bladder. When the bladder is full, we feel the need to urinate. Then, there is a tube that carries urine from the bladder to the outside of the body. That tube is called the urethra . In a man, sperm also exits the body through this urethra.

Now imagine what happens if this urethra becomes blocked or narrowed for some reason? Just like when dirt gets stuck inside a water pipe, it becomes difficult for water to flow, and urine cannot flow out easily. The surgery performed to restore and repair that blocked or narrowed urethra is called Urethroplasty .

In this procedure, the surgeon cuts out the scar tissue that is blocking the urethra and reconnects the two healthy parts of the tube. Sometimes, if the blockage is too long, a piece of tissue taken from another part of the body is used to reconstruct the part. It's like removing a piece of old water pipe and replacing it with a new piece.

Why is this surgery necessary?

There are several main reasons for undergoing urethroplasty. Let's take a look at what they are.

• Urethral stricture: This is the most common cause. Scarring inside the urethra can cause it to become narrow due to an infection, an accident, a previous surgery, or other cause. This condition is more common in men than women.
• Congenital conditions: Some children are born with certain problems with the urethra. Epispadias and hypospadias are two such conditions. Although these can be corrected surgically in childhood, they can later develop blockages in the areas where the surgery was performed.
• Other Reconstructive Surgery: This surgery may sometimes be necessary for someone who has had other reconstructive surgeries in the genital area.

Is Urethroplasty a major surgery?

This really depends on how much of your urethra needs to be repaired. If the blockage is small, the surgery to cut it out and join the two ends of the urethra together takes less time. But if the blockage is long, a piece of tissue (graft) from another part of the body may be used to repair the urethra. Then the surgery is a little more complicated and takes longer.

Where do you get this tissue?

There are several places where surgeons commonly obtain tissue for this purpose.

• From inside your mouth: Yes, you heard right. This tissue is most often taken from the smooth lining of your cheek (buccal mucosa) or the inside of your lips. This is a very successful method.
• From your genital area: If you are a man, a portion of the skin from your penis may be taken. In the case of reconstructive surgery, a portion of the skin from your vagina or labia may be taken.
• Rectal: While you are under anesthesia for the surgery, a piece of tissue may be taken from the inner wall of the rectum through the rectum.

Don't be afraid of this. All of this is done under complete anesthesia so that you don't feel any pain.

What happens before the surgery?

After deciding to have Urethroplasty surgery, your doctor will first perform several tests to determine exactly where the blockage is in your urethra and how long it is.

Both of these tests are quick and painless. The doctor will then schedule the surgery. A few days before the surgery, he will give you instructions on what medications to take, what to eat, and how long to fast.

Sometimes, your doctor may recommend that you have a suprapubic catheter placed before surgery. This involves inserting a tube directly into your bladder from your lower abdomen. This gives the urethra a "rest." The scar tissue is then clearly visible, making it easier to remove during surgery.

What happens during the surgery?

On the day of your surgery, you will be taken to the operating room. There, the anesthesiologist will give you general anesthesia . This means that you will be in a deep sleep until the surgery is over. You will not feel anything.

The surgeon then makes an incision in the skin to access the urethra. This incision is usually made on the underside of the penis, in the scrotum, or most commonly in the area between the scrotum and the anus (the perineum).

Next, the blocked or scarred area is identified and, depending on its length and location, the area is either cut out and removed or reconstructed. If the blockage is long, a graft is used to reconstruct the area, as discussed earlier, from the mouth, genitals, or rectum.

After the repair is complete, a catheter is placed to drain urine until the urethra heals. The incision is then closed and sutured. These sutures are usually made of a type of thread that dissolves into the body. So you don't have to come back to have the stitches removed.

What happens after the surgery?

After the surgery, you will be taken to the recovery room until you wake up from the anesthesia. Urethroplasty is usually a day or two hospital stay, and you can go home. Sometimes you can go home the same day. However, you cannot drive yourself, and someone will need to drive you home.

When you go home, you will need to take these things with you:

• Urinary catheter
• Painkillers
• Antibiotics to prevent infections
• Medications to prevent bladder spasms may be prescribed.
• If a tissue was taken from the mouth, a special mouthwash will be used to keep the wound clean.

You will need to see your doctor again in about two to three weeks after your surgery. At that time, you may have another X-ray to check the repair. This involves removing the catheter, filling your bladder with a special solution, and taking X-ray pictures while you urinate. These pictures will help determine your healing progress.

What are the benefits, risks, and complications of this surgery?

Like any surgery, this one has benefits as well as some risks.

Advantages

The biggest advantage of this surgery is its very high success rate . Research has shown that the success rate of this surgery is more than 80% . In some cases, depending on the nature of the blockage, the success rate can exceed 90% . This means that if 10 people undergo the surgery, 8 or 9 will make a full recovery.

Risks and Complications

There are common issues with anesthesia and the risk of infection that come with any surgery. In addition, there are some risks that are specific to this surgery. Let's take a closer look at those.

How long will it take to recover? When can I go back to work?

This is a problem that many people have. There are a few things you need to be aware of regarding the recovery period.

• While the catheter is in place: During this time (about 2-3 weeks), you should avoid driving or sitting for long periods of time . Also, avoid squatting or doing things with your legs spread wide (like climbing stairs) . However, it is okay to walk normally and do light household chores.
• Mouth sores: If you have a tissue cut in your mouth, don't worry. Mouth sores heal very quickly. In about 3 weeks, new tissue will grow and cover the area.
• Returning to work: You will be able to return to work after the catheter is removed. This means you will need to take about 2-3 weeks off. If you have a physically demanding job, it may take a little longer.
• Sexual activity: This is very important. You should completely refrain from sexual intercourse or masturbation for 6 weeks after surgery. This is essential for the wound to heal properly.

When do you need to see the doctor?

If you have difficulty urinating, frequent urinary tract infections (UTIs), or if a doctor has told you that you have a blockage in your urethra, you should definitely see a doctor and talk about this.

If you have had urethroplasty surgery and experience any of the following warning signs , you should contact your doctor immediately.

• If you get a fever .
• If the surgical incision looks open .
• If there are heavy blood stains on your underwear.
• If there is pus-like fluid coming out of the cut.
• If there is unexpected severe pain .
• If your catheter is blocked and no urine is coming out.

If you have any doubts about anything like this, don't ignore it. Call your doctor or hospital immediately for advice.