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Urologic Trauma, Reconstruction and Prosthetics

Urethral Reconstruction

Urethral Reconstruction Surgery

For most men, urethral reconstruction might sound frightening. But it doesn’t have to be.

There is no reason to live with the discomfort, embarrassment and uncertainty that comes with urethral strictures, including difficulty urinating, the pain often associated with it and the increased risk of urinary tract infections. Some men with urethral strictures have had to perform self-catheterizations to empty their bladder. In some cases, it can even affect their sex life.

Upfront Talk About Urethral Reconstructive Surgery

When you meet with Jay Simhan, MD, he will take the time to talk to you about the different surgical solutions available and which one is best for you.

Since the urethra is approximately 20-30 cm long in the average male, blockages can begin in parts of the urethra that are well before the start of the penis. More than likely, urethral stricture (or blockage) surgery, known as urethroplasty, will fall under one of several main categories depending on how long your stricture is and where it begins:

  • Excision with primary anastomosis urethroplasty for short segments of blockage that are not in the penis part of the urethra
  • Substitution urethroplasty for long segment blockages of the urethra, or for any blockage within the penis part of the urethra
  • Pelvic fracture injury to the urethra caused by trauma leading to separation of the urethra near the prostate caused by trauma
  • Hypospadias repairs of the urethra in adults

In the case of primary anastomosis urethroplasty, a single incision is made underneath the scrotum and the scar tissue is removed while the remaining healthy urethra is reconstructed. The surgery takes a couple of hours and patients can go home the same day or stay one night in the hospital.

Substitution urethroplasty is typically only necessary for longer blockages or for those blockages in the penile part of the urethra. The problem here is that the urethra has been aversely affected for long enough that there’s too much scar tissue to simply remove and reattach the healthy portions. Many times the urethra gets “replaced” by normal tissue elsewhere in the body. This often involves tissue removed from the mouth and the reconstructed within the urethra.

Pelvic fracture urethral injuries are often a result of severe trauma to the urethra. Many of these patients are referred to Dr. Simhan by a community urologist or hospital-based urologist after the patients have had the placement of a suprapubic tube to control the area of the injury. Suprapubic tubes are literally tubes that enter the abdomen (right above the penis) and go directly into the bladder, thus bypassing the urethra. These patients are usually unable to have catheters through their penis because the urethra itself has been disrupted from its normal path – and a reconstructive surgeon has to undertake a repair to reconnect the urethra so that it is one continuous organ. 

Hypospadias is a condition boys are born with that results in the urethra not ending at the tip of the penis. A pediatrician often diagnoses this condition and a pediatric urologist then undertakes repairs of the urethra in young boys. Although these are often successful for many years, plenty of men once they reach adulthood might develop a narrowing of the reconstructed urethra. Dr. Simhan is an expert at reconstructing the urethra of adult men that have a narrowing or blockage of the hypospadias penis. This surgical repair is called a reoperative or redo hypospadias surgery – and many times patients need a procedure called “staged urethroplasty.”

Don’t Let Urethral Strictures Stop You

Standard recovery time after urethral reconstruction surgery with Dr. Simhan is surprisingly short.

While you’re strongly cautioned not to participate in any strenuous activities for four weeks to allow for proper healing, you can be back to work within just a week depending on the exact nature of your job and how your body is healing.

The stitches will dissolve on their own in 14-21 days, so there’s no need to worry about having to have them otherwise removed.

If all goes well, you can be fully back to your normal habits a month after surgery.

 


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Urethral Reconstruction Specialists

Karl’s Story

After a near fatal motorcycle accident, it wasn’t until he discovered the experts at Einstein Urology that his real internal issues were healed. We treat patients like Karl every day.

 

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