Our Summary

This research paper talks about a type of scarring in the male urinary tract, or the tube that carries urine out of the body, which can decrease the flow of urine. Treating this problem surgically has evolved significantly over the years. Currently, the best method for treating this condition when it can’t be removed and directly repaired is a procedure called substitution urethroplasty. This involves using tissue grafts or flaps to repair the strictures.

The best material for this procedure is oral mucosa, which is the lining of the mouth, often taken from the inner cheek. Recently, the lining from the underside of the tongue has also been used with similar results. Depending on the specific location and severity of the stricture, different techniques can be used to place the graft, either on the underside or top side of the tube.

Most strictures in the penile part of the urinary tract can be repaired in a single surgery using various techniques, but more complex cases, such as those associated with certain skin conditions or failed previous surgeries, may require a staged approach. This paper provides a detailed overview of the process of using oral mucosa grafts for this type of surgery and reviews the latest topics in this field.

FAQs

  1. What is substitution urethroplasty and when is it used?
  2. What is the best material used for substitution urethroplasty and where is it usually taken from?
  3. Can all urinary tract strictures be repaired in a single surgery, or are there cases that require a staged approach?

Doctor’s Tip

A helpful tip a doctor might tell a patient about urethroplasty is to follow the post-operative care instructions carefully to ensure proper healing and a successful outcome. This may include avoiding strenuous activities, keeping the area clean and dry, and taking any prescribed medications as directed. It is also important to attend follow-up appointments with your healthcare provider to monitor progress and address any concerns. By following these guidelines, you can help optimize the results of your urethroplasty procedure.

Suitable For

Patients who are typically recommended for urethroplasty are those with a narrowing or scarring in the male urinary tract that is causing a decrease in urine flow. This condition, known as a urethral stricture, can be caused by various factors such as trauma, infection, or previous surgeries. Patients with more complex cases, such as strictures associated with certain skin conditions or failed previous surgeries, may require a staged approach to treatment.

The best candidates for urethroplasty are those with strictures in the penile part of the urinary tract that can be repaired in a single surgery using tissue grafts or flaps. The most common material used for this procedure is oral mucosa, taken from the inner cheek or underside of the tongue. This tissue is preferred for its durability and ability to heal well in the urinary tract.

Overall, patients who are experiencing symptoms of a urethral stricture, such as difficulty urinating, urinary retention, or recurrent urinary tract infections, may be recommended for urethroplasty to improve their quality of life and urinary function. It is important for patients to consult with a urologist or specialist to determine the best course of treatment for their specific condition.

Timeline

Before urethroplasty:

  1. Patient experiences symptoms such as decreased urinary flow, difficulty urinating, frequent urinary tract infections, and pain or discomfort during urination.
  2. Patient undergoes diagnostic tests such as urethral imaging, cystoscopy, and uroflowmetry to determine the location and severity of the stricture.
  3. Patient may undergo dilation or urethrotomy as temporary measures to alleviate symptoms.
  4. If the stricture is severe or recurring, patient is recommended for urethroplasty surgery.

After urethroplasty:

  1. Patient undergoes pre-operative preparations, including medical evaluation, imaging studies, and discussion of surgical options.
  2. Urethroplasty surgery is performed, typically using oral mucosa grafts to repair the stricture.
  3. Patient undergoes post-operative care, including catheterization to allow the graft to heal properly.
  4. Patient is monitored for complications such as infection, urinary retention, or recurrence of the stricture.
  5. Patient undergoes follow-up appointments to monitor healing and urinary function.
  6. In most cases, patient experiences improved urinary flow and resolution of symptoms following successful urethroplasty surgery.

What to Ask Your Doctor

  1. What is the success rate of urethroplasty using oral mucosa grafts for treating strictures in the male urinary tract?
  2. What are the potential risks and complications associated with urethroplasty surgery?
  3. How long is the recovery period after undergoing urethroplasty surgery?
  4. Are there any specific care instructions or restrictions that I should follow after the surgery?
  5. What is the likelihood of the stricture reoccurring after undergoing urethroplasty surgery?
  6. Are there any alternative treatment options for my condition?
  7. How many urethroplasty surgeries have you performed, and what is your success rate with this procedure?
  8. Can you provide me with information about the specific technique you plan to use for my surgery?
  9. Will I need to undergo any additional tests or evaluations before the surgery?
  10. What is the expected outcome or prognosis following urethroplasty surgery for my specific condition?

Reference

Authors: Horiguchi A. Journal: Int J Urol. 2017 Jul;24(7):493-503. doi: 10.1111/iju.13356. Epub 2017 Jun 10. PMID: 28600871