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Urethra Surgery


Urethra Surgery

What is the Urethra?

The Urethra is the opening that allows urine to leave the bladder:

  • In men, it is a thin tube-like structure that starts from the lower opening of the bladder and traverses the entire length of the penis.
  • In women, it is a shorter opening coming off the lower opening of bladder and is between 2.5 to 4 centimeters (cm) in length.

The Urethra has a Sphincter which is normally closed to hold urine inside the bladder. When the bladder fills, there are both voluntary and involuntary controls to open the urethral sphincter to allow urine to come out.

 

 

What Is A Urethral Stricture?

Urethral Stricture refers to any narrowing of the Urethra for any reason - whether or not it actually impacts the flow of urine out of the bladder and is significantly more common in men and boys compared to women and girls. Any inflammation of Urethra can result in scarring, which then can lead to a stricture or a narrowing of the urethra including:

  • Trauma  -  Pelvic injury or accidents with damage to the Urethra or Bladder
  • Infection - Prostatitis, sexually transmitted diseases or STDs, Urethritis, Gonorrhea
  • Tumors – Cancer,
  • Surgeries- Previous procedures involving the urethra (TURP or Transurethral Resection of the Prostate, urinary catheters, etc.)

Symptoms of Urethral Stricture can range from no symptoms at all ,to mild discomfort, to complete urinary retention – the inability to urinate. Some of the possible symptoms and complications include the following:

  • Blood in the semen
  • Blood in the urine (bloody or dark-appearing urine) known as hematuria
  • Decreased urine stream
  • Difficulty starting urine flow
  • Discharge from the urethra
  • Dribbling of urine
  • Failure of conservative measures to control symptoms (pain)
  • Incomplete emptying of bladder
  • Increasing post-void residual (amount of urine left in bladder after urination)
  • Kidney stones in the bladder
  • Painful urination (dysuria)
  • Pelvic pain
  • Recurrent urinary tract infections
  • Reduced ejaculation force
  • Severe problems with urination and urinary retention
  • Spraying or double streaming urine
  • Surgery may be recommended in the following circumstances:
  • Urinary incontinence (loss of bladder control)
  • Urinary retention
  • Urinary tract infection (UTI)

SURGICAL TREATMENT OF URETHRAL STRUCTURE

Many surgical procedures are available for treating Urethral Strictures.

 

PREPARATION FOR SUREGERY

Before traveling to Cyprus, as part of your surgery preparation you will complete a detailed specific questionnaire, which will allow our doctors to determine your eligibility for chosen procedure.

Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.

Before your departure your records will be reviewed thoroughly by our surgeon. This includes X-rays and a complete medical and surgical history as well as your specific issues.

After traveling to Cyprus, a new set of X-rays will be taken as well as an in person physical examination.

The surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your procedure and answer any questions.

Preparation for the hospital

Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:

Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:

  • Loose shorts or pants
  • Loose tops or T-shirts
  • Underwear and socks
  • Short robe or pajamas
  • Toiletries

Morning of surgery

Bring all your medicines in their original containers with you to the hospital. You will meet with the anesthesiologist. This doctor will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery. You will have an IV or intravenous line put in to give you fluid and medicine during your surgery. When it is time for you to go to surgery, your family will be asked to wait in the waiting area. Your doctor will talk to your family there after your surgery is done.

 

RECOVERY AFTER SURGERY

When you wake up after your surgery, you will be in the recovery room. You will stay there until you are awake and your pain is under control. Most patients return to their room after a few hours.

You will have an analgesia pump device to deliver pain medication into your IV or epidural space (in your spine). You will also have compression boots on your lower legs to help your circulation. They will be taken off when you are able to walk.

You will most likely be tired and a bit sore for a few days. You may have pain not only from your incision, but also from muscle soreness in your upper back and shoulders. This is from the positioning in the operating room during the surgery. You will have liquid pain medicine in the hospital and a prescription for pain pills at home.

You may have a sore throat. This is a result of the placement of anesthesia tubes during surgery. Throat lozenges and spray usually help. 

Your scrotum may be slightly swollen as well.  This will improve after a few days but may continue for a week or so. 

You may have stinging and possible trouble initiating the urinary stream, however this will be overcome within the first few days post operatively.

Hospital discharge and home instructions

The recovery course will depend on the extent of your surgery, however normally 1 night hospitalization is necessary.

Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom etc.

Prior to being discharged, you will receive the following instructions for care of areas of the body that may be affected by lymph node removal:

  • All incisions to the area should be properly cleaned, treated with an antibiotic ointment, and covered with a bandage.
  • Heavy lifting should be avoided; bags should be carried on the unaffected arm.
  • Tight clothing should be avoided.

You will be able to leave the hospital when you are:

  • Able to eat a regular diet and drink fluids
  • Passing gas or you have had a bowel movement
  • Passing urine
  • Not having a fever or other signs of infection
  • Walk for short distances

LIFE AFTER SURGERY

These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your surgeon’s discharge instructions if they are different from what is listed here:

  • Most people take 2-4 weeks to recover. 
  • You may resume most of your normal activities the day after surgery. Avoid heavy lifting or active exercise (walking is encouraged) for 2 weeks.
  • You should not drive for at least a week.

If you notice sudden swelling contact our surgeon immediately.  This will be monitored through blood tests. 

Medications

Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.

  • For pain

Your surgeon will order a prescription pain medicine for you after surgery. As your pain lessens, over the counter pain medicines such as acetaminophen or ibuprofen can be used. They can also be used instead of your prescription for mild pain.

  • For constipation

Prescription pain medicines can cause constipation. Your doctor may order a stool softener to prevent this. You should be back to your normal bowel routine in about 2 weeks. If the stool softener does not work, take Milk of Magnesia. If you still are not getting relief, call your surgeon.

 

FOLLOW-UP

Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need.

Depending on the cause and other medical and social aspects, the most appropriate procedure will be recommended for you by our surgeons. Common procedures include: