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In men, the urethra carries urine from the bladder out of the body through the penis. The urethra may have a narrowing (stricture) that blocks the normal flow of urine. As a result, urine can back up in the kidneys and ureters (tubes that carry urine from the kidneys to the bladder). This can lead to infection and kidney damage. Urethroplasty is surgery to treat a stricture. This sheet explains the surgery and what to expect.
Prepare for the surgery as you’ve been told. In addition:
Tell your doctor about all medications you take. This includes herbs and other supplements. It also includes any blood thinners, such as Coumadin, Plavix, or daily aspirin. You may need to stop taking some or all of them before surgery.
Do not eat or drink during the 8 hours before your surgery. This includes coffee, water, gum, and mints. (If you have been instructed to take medications, take them with a small sip of water.)
The surgery takes about 3-6 hours. Afterward, you will stay in the hospital for 1-3 nights.
Before the surgery begins:
An IV line is placed in a vein in your arm or hand. This supplies fluids and medications (such as antibiotics).
To keep you free of pain during the surgery, you’re given general anesthesia. This medication puts you in a state like deep sleep through the surgery. A tube may be inserted into your throat to help you breathe.
During the surgery:
Incisions are made near the area that needs to be repaired. This may be in the skin between the scrotum and anus. This may also be on the penis.
The method used to repair the stricture is chosen based on the location and length of the stricture.
First, the stricture is cut out. The remaining ends of the urethra may then be sewn together. Or, the urethra may be repaired with skin and tissue taken from another part of the body, such as the inside of your mouth.
In some cases, more than one surgery may be needed to repair the urethra. This is called a two-stage repair. Your doctor can tell you more.
When the surgery is complete, the skin incisions are closed with stitches (sutures).
A thin tube (Foley catheter) is placed into your bladder. Another thin tube (suprapubic catheter) may be placed through a small incision in your abdomen, into your bladder. These tubes help drain urine until healing is complete.
After the surgery, you will be taken to a recovery room. Here, you’ll wake up from the anesthesia. You may feel sleepy and nauseated. If a breathing tube was used, your throat may be sore at first. When you are ready, you will be taken to your hospital room. While in the hospital:
You will be given medication to manage pain. Let your providers know if your pain is not controlled.
As soon as you’re able, you’ll get up and walk.
You’ll be taught coughing and breathing techniques to help keep your lungs clear and prevent pneumonia.
After your hospital stay, you will be released to an adult family member or friend. Have someone stay with you for the next few days, to help care for you. Recovery time varies for each person. Your doctor will tell you when you can return to your normal routine. Until then, follow the instructions you have been given. Make sure to:
Take all medications as directed.
Care for your incisions as instructed.
Care for your catheters as instructed. Make sure nothing pulls on the catheters (such as clothing).
Follow your doctor’s guidelines for showering. Avoid swimming, bathing, using a hot tub, and other activities that cause the incision to be covered with water until the doctor says it’s okay.
Avoid heavy lifting and strenuous activities as directed.
Avoid sex for 4-6 weeks.
Avoid driving until your doctor says it’s okay. Do not drive if you’re taking medications that make you drowsy or sleepy.
Wear a jockstrap for support as directed.
Walk a few times daily. As you feel able, slowly increase your pace and distance.
Avoid straining to pass stool. If needed, take stool softeners as directed by your doctor.
Drink plenty of water. This prevents urine odor and dehydration. And follow any other diet instructions you’re given.
Chest pain or trouble breathing (call 911)
Fever of 100.4°F or higher
Symptoms of infection at an incision site, such as increased redness or swelling, warmth, worsening pain, or foul-smelling drainage
Pain that cannot be controlled with medications
Increased bruising or swelling of the penis or genital area
Problems with the catheters
Trouble urinating or no urine from your catheters for 4 hours
Bloody urine with clots (some pink-tinged urine is normal)
Nausea or vomiting that doesn’t go away
Pain or swelling the legs
You’ll have follow-up visits so your doctor can check how well you’re healing. Catheters will likely be removed after 2-3 weeks. If you have sutures that need to be removed, this will happen within 14 days (some sutures dissolve on their own). Tests may be done to make sure the stricture was repaired correctly and has healed well. And you may need more tests or procedures to ensure there are no problems after surgery.
Bleeding (may require a blood transfusion)
Failure to repair the stricture or recurrence of the stricture
Urine leakage at the repair site
Scarring of the urethra
Problems passing urine
Change in appearance of the penis
Change in ability to ejaculate or have an erection
Risks of anesthesia (the anesthesiologist will discuss these with you)