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A. Open repair of the urethra for a stricture using a graft (a piece of cheek lining i.e. buccal mucosa or under surface of tongue o.e lingual)).
A. The alternatives include:
A. If you are taking blood thinning medication on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits. Aspirin does not usually need to be stopped but will be the decision of your surgeon.
You will usually be admitted on the same day as your surgery, or a day before. You will normally undergo pre assessment on the day of your clinic. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and nurse.
You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist 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:
A. Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you.
You will usually be given an injectable antibiotic before the procedure after checking for any drug allergies.
An incision is made 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 graft may be taken from the under surface of the tongue. 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. If a graft is taken from the tongue, stitches are usually placed. A small dressing (pack) is usually inserted into the mouth to prevent bruising or swelling.
A. If a graft has been taken from the cheek lining, a pack will be removed from your mouth on the same day or the following day. Antiseptic and anaesthetic 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.
If a drain is placed, the drain will in the perineum/scrotum and removed after 36 to 48 hours.
The average hospital stay is 24 to 48 hours.
A. Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.
Common (greater than one in 10)
A. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation.
There may be some discomfort from the catheters and antibiotics usually needed for a period after surgery and are often needed until the catheter is removed.
When you get home, you should drink twice as much fluid as you would normally for the next 24 to 48 hours to flush your system through. You may find that, when you first pass urine, it stings or burns slightly and it may be lightly bloodstained. If you continue to drink plenty of fluid, this discomfort and bleeding will resolve rapidly.
Physical activity will generally be restricted for two to three weeks.
Jaw movements may be restricted if a graft has been taken from the cheek lining and wide opening of the mouth is encouraged.
A. If you develop increasing pain, wound discharge or swelling, you should contact your urologist immediately. Men who undergo surgery in the perineum (between the anus and the scrotum) may find it easier to sit with your weight shifted onto one of your buttocks.
You may find it more comfortable to sit using an air-filled donut, soft cushion or another type of pillow, especially for the first four weeks after surgery. Any activity that requires you to straddle anything, such as riding a bicycle, motorcycle or a horse should be avoided for four to six weeks.
Before the catheter is removed, an X ray (urethrogram) will be arranged alongside the catheter in the penis, approximately three weeks after your operation, to ensure that the area has healed. If the X ray is satisfactory, the catheter in the penis will be removed. If healing is not complete on the X ray, the catheters will need to remain in place and a further X ray will be arranged after another three weeks.
After catheter removal, you will be followed up in the outpatient clinic after 12 weeks with a flow test.
A. When you have: