Anterior urethroplasty with oral graft: procedure-specific information
What does the procedure involve?
Open repair of the urethra for a stricture close to the bladder (occasionally performed immediately after severe injury to the urethra)
What are the alternatives to this procedure?
Observation, repeated stretching using metal/plastic dilators
What should I expect before the procedure?
You will usually be admitted on the day of your surgery. After admission, you will be seen by members of the medical team. You will be asked not to eat or drink starting midnight before surgery and, immediately before the operation, you may be given a pre-medication by the anesthetist which will make you dry-mouthed and pleasantly sleepy.
Please be sure to inform your Urologist in advance of your surgery if you have any of the following:
? an artificial heart valve
? a coronary artery stent
? a heart pacemaker or defibrillator
? an artificial joint
? an artificial blood vessel graft
? a neurosurgical shunt
? any other implanted foreign body
? a prescription for Warfarin, Aspirin or Clopidogrel (Plavix®)
? a previous or current MRSA infection
? high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human-derived growth hormone)
What happens during the procedure?
Normally, a full general anesthetic will be used and you will be asleep throughout the procedure.
You will usually be given an injectable antibiotic before the procedure after checking for any drug allergies.
An incision is made over the stricture either on the penis or in the skin between the scrotum and the anus (the perineum). The scar is either cut away and the urethra re-joined over a catheter or widened with a piece of cheek lining (buccal mucosa) over a catheter. A drain may be inserted and possibly a second catheter placed in the bladder through the lower abdomen. The wound is closed with absorbable sutures. If a graft is taken from the cheek lining, this area heals quickly and does not require any stitches.
What happens immediately after the procedure?
If a graft has been taken from the cheek lining, liquids and a soft diet will be needed until the mouth heals. Antiseptic and anesthetic mouthwash will be used regularly and wide opening of the mouth is encouraged. You are allowed to eat and drink straight after the operation but it may be a few days before you are fully comfortable with doing that.
The average hospital stay is 1 to 3 days.
Are there any side-effects?
Most procedures have a potential for side-effects.
You should be reassured that, although all these complications are well-recognized, the majority of patients do not suffer any problems after a urological procedure.
Common (greater than 1 in 10)
¨ Discomfort in the mouth and restricted jaw opening if a graft has been taken from the cheek lining
¨ Swelling and bruising of the wound site
¨ Recurrent stricture formation requiring further surgery or other treatment
Occasional (between 1 in 10 and 1 in 50)
¨ Failure of the procedure requiring further surgery
¨ Wound infection requiring antibiotics
¨ Failure of the urethra to join completely, resulting in urinary leakage (a fistula)
¨ Loss of or altered erections as a result of injury or surgery to the urethra
¨ Need to carry out self-catheterization to keep the urethra open
¨ Dribbling post-operatively due to “bagginess” of the graft
¨ Shortening of the penis
Rare (less than 1 in 50)
¨ Painful intercourse with reduced ejaculation
Hospital-acquired infection
¨ Colonization with MRSA (0.02%, 1 in 5,000)
¨ Clostridium difficile bowel infection (0.04%; 1 in 2,500)
¨ MRSA bloodstream infection (0.01%; 1 in 10,000)
(These rates may be greater in high-risk patients e.g. with long-term drainage tubes, after removal of the bladder for cancer, after previous infections, after prolonged hospitalization or after multiple admissions)
What should I expect when I get home?
When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your PCP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.
There may be some discomfort from the catheters and antibiotics are usually needed until the catheter is removed.
Physical activity will generally be restricted for 2-3 weeks.
Jaw movements may be restricted If a graft has been taken from the cheek lining and wide opening of the mouth is encouraged.