Urethraplasty

The urethra is a tubular organ of the human body that is responsible for urination and the excretion of sperm in men. Between the female and male urethra there are noticeable differences not only in functionality, but in size, properties and location. However, both organs can be subject to pathological changes. One of them is urethral stricture. The disease worsens the quality of life, causes pain, discomfort, and incomplete emptying of the bladder. Urethral plastic surgery is used to neutralize strictures. What you need to know about plastic surgery, how exactly does the operation take place and how to properly prepare for the intervention?

General characteristics of the intervention zone

The urethra or urethra is an unpaired tubular organ of the human body (also found in vertebrates). It connects the bladder with the external environment and is responsible for the excretion of biological fluids – urine and semen. In men, a significant part of the urethra passes inside the penis, and the external opening of the canal is located at the top of the head of the penis. The urethra of women is “hidden” in the pelvic cavity. The external opening is located in the folds of the mucosa before entering the vagina.

Do organs differ by gender? Yes, the main difference is functionality. The female urethra is responsible only for urination, while the male urethra is responsible for two functions at the same time – the excretion of urine and sperm. The male urethra is larger than the female urethra, but inferior in diameter. The female urethra stretches better, is at greater risk of infection, and needs less blood supply.

What you need to know about stricture

Stricture or stenosis is a persistent narrowing of the lumen of any hollow anatomical structure of the human body. Pathological narrowing develops in 1-2% of men and 0,5% of women. What does this lead to? It is difficult to excrete urine, and the process itself is accompanied by pain, discomfort, splashing of fluid and a feeling of incomplete emptying of the bladder. The disease is more common in men than in women. This is due to the greater length and specificity of the structure of the urethra.

Untimely access to a doctor or refusal to treat stenosis can lead to the development of cystitis, pyelonephritis, urolithiasis, renal failure, hydronephrosis, and urinary outflow disorders.

The condition is acquired and can develop under the influence of trauma (70% of cases), inflammation (15% of cases), iatrogenic factors (13% of cases). Iatrogenic factors include medical errors, medical negligence, inappropriate treatment, or unwanted drug interactions. Narrowing of the lumen of the male urethra can occur after pelvic fractures, penetrating wounds, perineal blunt trauma, penile fracture, sexual excesses, chemical/thermal injuries. The stricture of the female urethra most often occurs after birth trauma or amputation of the cervix.

The development of a stricture occurs in several stages. First, the urothelium and the mucous membrane of the organ are damaged, then urinary streaks form, the layering of a secondary infection and tissue destruction.

Diagnosis of stenosis

Before starting therapy, the doctor must confirm the diagnosis and identify the cause of the narrowing. This requires the following tests and diagnostic manipulations:

1. PCR diagnostics (polymer chain reaction). The study of human genetic material (DNA / RNA) in order to identify numerous infections.
2. Urogenital bacteriological culture. The medical officer studies the number and properties of microorganisms obtained from the sample in different environments.
3. General urine analysis. The study of color, transparency, acidity, specific gravity, the presence of a number of specific substances (protein, blood cells, glucose, bile pigments).
4. Uroflowmetry (fixing the volumetric flow rate of urine), cystometry (examination of the bladder), video urodynamics (visualization of the urinary tract).
5. Ultrasound examination of the bladder. Diagnosis is carried out immediately after urination. This helps to determine the volume of excreted and residual fluid. The method evaluates the degree of decompensation of urination function.
6. X-ray. Indicates the location, size of the stricture. Helps to identify stones in the urethra or bladder, diverticula or false passages.
7. Endoscopy. General examination of the urethra, which helps to identify the likely causes of stenosis and perform a tissue biopsy.

Urethral plastic surgery: varieties, course of operation and its consequences

The attending physician is engaged in drawing up a therapeutic course. He assesses the patient’s condition, selects the optimal method of surgical intervention, assesses possible risks and performs the operation. There are three main types of urethral plastics – bougienage, endoscopic urethrotomy and open urethroplasty. What is the difference?

Bougienage of the urethra

The most common method of plastic surgery of the urethra. It is used in the development of a simple, single, unextended constriction. Bougienage must be repeated several times, as the disease can recur. Upon completion of the bougienage, the patient will have a short recovery period. He is prescribed a course of antibiotics to prevent the development of the inflammatory process. Additionally, the surgeon selects individual recommendations for care, nutrition, physical activity in each case.

How is the operation going? The patient is placed on his back in a special chair, prepared for manipulation and anesthesia is administered. The doctor then lubricates the bougie (an instrument for expanding tubular organs) with a gel that will ensure safe and easy insertion. For female patients, a bougie with an oval ring is used, for male patients, a thin elongated tube, more like a dense thread. The instrument is inserted through the urethra to the bladder, expanding the urethra. Manipulations are repeated several times using instruments of different diameters. The size of the bougie is increased until it becomes difficult to remove the tube.

Endoscopic (optical) urethrotomy

This is an operation to cut the stricture of the urethra with the help of an endoscope. Manipulations are carried out under the visual control of a specialist. The endoscope is equipped with a special device that displays an image of the internal cavity on the monitor. The doctor monitors the image in real time, evaluates the condition of the urethra and corrects the narrowing.

Before the intervention, the patient is given anesthesia. Through the urethra, the doctor inserts an endoscope, which performs two functions at once – it finds constrictions and dissects them. The method is contraindicated in acute inflammatory, purulent processes in the body, regardless of their location. The operation can be carried out only after their cupping.

Open urethroplasty

This is a standard abdominal operation, which is necessary for extended strictures (more than 2 centimeters). Before the intervention, the patient must take laxatives to cleanse the colon, shave the inguinal area and adhere to specific dietary restrictions. The duration of the operation varies from 2 to 5 hours and requires the coordinated work of medical staff.

The patient is given general anesthesia, after which the perineum is incised. The length of the incision can reach 7 centimeters. The surgeon finds the narrowing, cuts it out, and sews in “new” tissue. Most often, a new flap is removed from the buccal mucosa or skin of the foreskin before intervention. The cheek and urethra are sutured, treated with antiseptic substances, after which the patient is transferred to the hospital. The length of stay in the hospital depends on the patient’s response, but most often does not exceed 10 days. The patient is prescribed a course of antibiotics, the postoperative wound is treated and bandaged daily.

Prognosis and prevention

Despite the operation, it is impossible to reduce the risk of recurrence to zero. After bougienage of the urethra, it is more than 50%. When using other methods, the risk is reduced and depends on the patient’s vital activity, the body’s response to the operation. In order to notice the re-narrowing in time, it is necessary to visit the urologist regularly, monitor the nature of urination and undergo routine diagnostics.

Can stenosis be prevented? A person can minimize the risk of disease, but not completely eliminate it. It is enough to visit a urologist at least 1-2 times a year, in a timely manner to identify and treat problems of the urogenital system. You should also remember about the prevention of STDs, exclude mechanical / chemical / thermal / combined damage to the genitals.

Urethraplasty is one of the possible treatments for urethral stricture. Pathology can develop in both men and women, but, according to statistics, males are more likely to suffer from narrowing of the urethra. The disease interferes with normal urination, provokes pain, discomfort and reduces the overall quality of life. If you notice these symptoms, contact your urologist. He will select the optimal method of therapy, give recommendations on postoperative care and relapse prevention. The main thing – do not self-medicate and do not try to correct the condition with folk methods.