Urethroplasty

Urethroplasty is a surgical procedure used to treat urethral strictures, which are narrowings of the urethra caused by scar tissue. This condition can lead to difficulty urinating, pain, urinary tract infections, and other complications. Urethroplasty is considered the gold standard treatment for urethral strictures because it offers a long-term solution compared to temporary relief provided by other treatments like dilation or internal urethrotomy.

Types of Urethroplasty

End-to-End Anastomosis: This technique is typically used for shorter strictures (less than 2 cm). The scarred segment of the urethra is excised, and the two healthy ends are then stitched together.
Substitution Urethroplasty: Used for longer strictures, this method involves replacing the scarred section of the urethra with a graft or flap of tissue. The tissue might be taken from the patient’s own body (autograft), such as:
- Buccal Mucosa Grafts: Tissue from the inside of the cheek, which is the most common source due to its robustness and ease of harvesting.
- Skin Grafts: Less commonly used due to less favorable outcomes.
- Bladder Mucosa Grafts: Occasionally used for complex cases.
Onlay Graft Urethroplasty: A variation of the substitution technique where the graft is placed on only one side of the opened urethra, typically used when the other side of the urethra has a healthy blood supply.
Augmented Anastomotic Urethroplasty: Combines the excision and primary anastomosis with a tissue graft, typically used for longer strictures with unhealthy urethral segments.

Indications for Urethroplasty

Recurrent Urethral Strictures: After failure of less invasive treatments like urethral dilation or urethrotomy.
Long or Complex Strictures: Particularly those caused by trauma, infection, or previous surgeries.
Symptomatic Relief: For patients experiencing significant symptoms that affect quality of life.

Risks and Complications

Recurrence of Stricture: Although urethroplasty has a high success rate, strictures can recur.
Infection: Risk of infection at the surgical site.
Urinary Incontinence: Rare but possible, especially if the sphincter muscles are affected.
Erectile Dysfunction: Potential risk depending on the location and extent of the surgery.
Fistula Formation: An abnormal connection between the urethra and the skin.

Recovery

Recovery from urethroplasty typically involves temporary urinary catheterization to allow the urethra to heal without the stress of normal urination. Patients may need a catheter for 2-3 weeks post-surgery. Pain and discomfort can be expected but are generally manageable with medications. Most patients can return to normal activities within a few weeks but may need to avoid strenuous activities for up to 6 weeks.

Outcome

The success rate for urethroplasty is generally high, with many studies reporting success rates of 85-90% or higher. Patient satisfaction tends to be very high due to the significant improvement in urinary symptoms and overall quality of life.

Urethroplasty remains a highly effective surgical option for those suffering from urethral strictures, offering durable results and an improvement in life quality.

With years of experience in reconstructive urology, Dr. Mishra's patients benefit from his deep expertise in urethroplasty, which is reflected in the high success rates and positive patient testimonials. His meticulous approach to surgical planning and execution, combined with state-of-the-art medical facilities, ensures that patients receive the best possible care.

Dr. Saurabh Mishra’s dedication to advancing urological health through innovative surgical solutions like urethroplasty allows patients to achieve significant improvements in urinary function and overall well-being.