Overview: Urethroplasty is an operation for the repair of an injury or a defect in the walls of the urethra. This surgical procedure is conducted to correct scar tissue blockage of the urethra called urethral stricture. The urethra is the tube that carries urine from the bladder (through the penis in males) to the outside of the body. A urethral stricture can occur anywhere in the urethra. A urethral stricture is a scarred or hardened area that causes narrowing of the caliber of the urethra. The stricture eventually reduces or obstructs the flow of urine out of the bladder, making it difficult to urinate. The bladder therefore must work harder to push the urine through the narrowed area of the urethra.
Symptoms of Urethral Strictures:
Symptoms of urethral stricture can range from no symptoms at all (asymptomatic), to mild discomfort, to complete urinary retention (inability to urinate). Some of the possible symptoms of urethral stricture include the following:
Reduction in urine flow rate
Prolonged time needed to empty the bladder.
Frequent urination during day and night called nocturia
Sudden urges to urinate (urgency)
Sensation of incomplete emptying
Urine infections can occur.
Causes of Urethral Strictures: Most urethral strictures arise from an injury to the urethra. Common causes of urethral stricture include:
A common urethral stricture cause is straddle trauma injury to the urethra.
When the pelvis is fractured, in some cases there is an associated tear of the membranous portion of the posterior urethra. In most cases the ends separate, and the patient is completely unable to urinate.
Men with Lichen Sclerosus have whitish discoloration of the penile skin and can develop strictures involving the meatus alone, or longer strictures.
Hypospadias treatment with surgery may become complicated by urethral stricture development.
Other Urologic Procedures may damage urethral opening.
The above represents the most common causes of strictures. Other causes include foreign body insertion into the urethra and urologic surgeries such as penile implant surgery.
Diagnosis of Urethral Strictures:
Your doctor will ask about your symptoms and your medical history and conduct a physical exam. Your doctor may recommend a number of tests to pinpoint the cause, location and length of the urethral stricture, including:
Complete physical examination
Urethroscopy/Cystoscopy and Calibration
Urethral X-Ray Imaging
Bladder scan to check the Post Void Residual
Other non-invasive test to measure the flow rate is called a Uroflow
Ultrasound and MRI of the urethra are other imaging tests that can be utilized
Preparation for Urethroplasty Surgery:
A thorough pre-operative assessment by your urologist would comprise of
urinalysis for the presence of blood and white cells,
urine culture for infection and
Cystoscopy to confirm the diagnosis of urethral stricture
The standard urethral imaging procedures like Retrograde Urethrogram (RUG) and Voiding Cystourethrogram (VCUG) will also be performed.
You will be hospitalized at least one day before the surgery. Inform your surgeon about your other health conditions and medications (including all the prescription, non-prescription medications, nutritional supplements i.e. vitamins, minerals and herbal products). Refrain from taking aspirin or Ibuprofen at least 2 weeks before Urethroplasty. Stop smoking a few weeks before Urethroplasty to prevent healing problems during recovery period. Do not eat or drink anything for at least 10 - 12 hours before the Urethroplasty.
Urethroplasty Surgery Procedure:
It involves surgery to remove the involved segment and re-attach the two normal ends. This is called excision and primary anastomosis. This procedure is best suited for short strictures involving the bulbar or membranous urethra in particular. When this repair is not possible, tissue can be transferred to augment and therefore widen the narrow segment to a normal caliber. For example, the urethra can be augmented using penile skin. Other tissues that can be used to reconstruct the urethra include a graft of buccal mucosa (skin inside the cheek). When the above procedures are not an option, alternatives include a two-stage repair where a buccal mucosa and/or a split-thickness skin graft is placed along the undersurface of the penis, and later rolled into a new urethra (neo-urethra). The choice of repair is individual and influenced by the length and location of the stricture, the availability of local tissue, and other factors. Surgery is performed uder genral anethesia.
Types of Urethroplasty Surgery:
Following are the various types of Urethroplasty surgery procedures available;
Urethroplasty for Lichen Sclerosis
Urethroplasties for Hypospadia
Urethroplasty for Epispadia
Follow Up Care Post Urethroplasty Surgery:
The follow up after urethroplasty surgery is very important; this is because most urethral strictures recur within the first year or two after surgery.
After surgery, a urethral catheter is left in for 2-4 weeks depending upon the type of surgery that was performed. When patients return to clinic the bladder is filled with X-ray contrast and the catheter is gently removed.
While X-rays are being taken, the patient voids and the area of the surgery is evaluated. If the area of surgery shows no leakage, the catheter is left out and patients begin to void normally.
Most urethral strictures recur within the first year or two after surgery. Patients are seen every 3-6 months in their first year after surgery.
Patients undergo cystoscopy of the urethra and the urinary flow rate and residual urine is measured.
In addition patients have a scope examination of the surgical area in which a flexible small scope is placed into the urethra from the penis, very similar to catheterization and the area of the surgery is examined for recurrent strictures.
Follow up schedule is individualized depending upon the findings of these exams.
Recovery After Urethroplasty Surgery:
Recovery time depends a lot on the type of surgery that was performed.
Typical patients will be in the hospital overnight after surgery. Once they are independent enough to manage the catheter they leave the hospital.
It is important to limit activities after urethroplasty until adequate healing has occurred. This means no heavy lifting, strenuous exercise or work for at least 2 weeks.
Generally, it is best if patients do not work while the catheter is in place, however, patients can start doing work that is not physical after 10-14 days.
The catheter can be worn draining to a smaller bag that straps to the lower leg under a pair of pants. Wearing a catheter like this is unobtrusive and very manageable.
Recurrence of Strictures:
When strictures come back after surgery they often are thin and web-like. These strictures can cause a lot of obstruction but often can be treated internally by cutting the stricture with a scope procedure. This is dissimilar to the initial stricture that often has too much scarring to respond long-term to an internal cutting procedure. Some strictures are too dense and do not respond to internal cutting and further surgery is indicated.
Benefits of Urethroplasty Surgery:
The success rate reported for Urethroplasty to treat urethral stricture is 70 80%. For people experiencing pain from a very narrow urethra, Urethroplasty procedure can seem like a miracle. It can also help eliminate frequent urinary tract infections. One must always weigh the benefits and risks before having surgery, and make sure to find a doctor that is trustworthy. Urethroplasty can give relief from many problems related to urination like Noctiria, reduction in urine flow rate, urine urgency, etc.
Urethroplasty Surgery in India: Indian hospitals offer the best urology care team which can move you quickly from diagnosis to recovery, Urologists at Indian hospitals can provide faster recovery with minimal scaring using both minimally invasive and reconstructive surgical techniques to treat urethral strictures and other diseases of the urinary tract. It is a fact that India provides best results in urethroplasty surgery. Most of the hospitals follow international standards of clinical care and provide the best health and medical care services. With latest technology, multi-disciplinary capability, state of the art facilities, world-class medical infrastructure and excellent ambience, urosurgery hospitals in India are poised to become the most advanced and progressive healthcare institution in this part of the world.
Cities in India offering Urethroplasty Surgery at top hospitals are as follows;
Cost of Urethroplasty Surgery in India:
The unparalleled commitment of the urosurgeons and other health professionals has led them achieve better outcomes and improved quality of life for millions of patients who visit India every year for urethra related diseases. Most of the Urosurgeons and urologists in India have been recognized for their contributions to the specialty through national and international awards. That makes India the most sought-after destination for uretheroplasty. The cost of Uretheroplasty if compared with other countries is extremely less. Many patients select India as they find treatment in India to be extremely cheap. Most of the patients end up saving at least 50% of their budget in India.
Cost Comparison of Uretheroplasty Surgery:
Some of the common countries from which patients travel to India for surgery are:
Located in South Asia, bordered by Pakistan, Nepal, China and Bangladesh, India is South Asia's largest, sovereign, democratic republic. India has an edge over other countries when it comes to offering comprehensive, cost-effective and timely medical care: it also offers an exotic, adventure-filled or cultural -if you wish array of destinations to discover and revel in for the travelers. Indian cities like Mumbai, Hyderabad, Goa, Bangalore, Nagpur, Kerala, Delhi, Pune, Jaipur, Chennai, Gurgaon, and Chandigarh offers best medical tourism service.
Mumbai - Formerly known as Bombay, is the commercial & financial capital city of India. Mumbai is famous for many things, including its thriving Bollywood film industry, teeming bazaars, colonial-style buildings, Art Deco structures and a superb choice of restaurants, often being rated as the dining capital of India. The tourist district of Colaba in Mumbai is a great place to start exploring this great city.
Hyderabad – Hyderabad city is a great place to visit in the state of Andhra Pradesh. The place has witnessed a continuous growth for last many years. Hyderabad has become a tourist hotspot following ever increasing number of tourists during past few years. Hyderabad has a well-founded reputation as one of the safest cities in the world.
Goa - The country's smallest state and famed for its colonial Portuguese and Catholic past, most tourists visit Goa for its endless selection of sandy beaches and coastal attractions. Standing proudly next to the Arabian Sea, Goa is a particularly compact state and often feels like a large town, being easy to travel. Around Goa, tourists will soon realize that the state has much more to offer than simply stunning beaches, fishing, water scooters, windsurfing and scuba diving.
Bangalore - Beauty lies in the eyes of beholder and if you want to see one of the most beautiful places in India then Bangalore is the word for it. Bangalore has earned sobriquets like 'Silicon Valley of India', 'Pub Capital of India', and 'City of Gardens'. Pleasant climate with colorful gardens with lakes and glittering nightlife, Bangalore has made its own attraction for travelers as one of the most charming cities in India,
Nagpur - Nagpur is the largest city in central India, but with its friendly atmosphere and dependable transportation, you’ll instantly feel at home. The city of Nagpur has a well-built infrastructure, is a clean and affluent city which makes a good jumping-off point for a series of trips into the far eastern corner of Maharashtra..
Kerala - Welcome to Kerala, state in India's southern tip and a state known as God's Own Country. Kerala is one of the ten 'Paradises Found' by the National Geographic Traveler, for its diverse geography and overwhelming greenery. It is a land much acclaimed for the contemporary nature of its cultural ethos, and much appreciated for the soothing, rejuvenating paradise that it is.
Delhi - Delhi, the capital of India is situated in the northern part of the country. Apart from being the capital of India, Delhi is also the travel hub of northern India. It serves as an excellent base for visiting the colorful state of Rajasthan, and Agra, the city of the Taj Mahal, is less than three hours away. Discover the many tales behind Delhi’s ancient, bewitching existence. Feel the excitement of stepping foot on a piece of the world’s oldest land!
Pune - Pune is the eighth largest city in the India state of Maharashtra. The city derives its name from Punya Nagari, which means 'the city of virtuous deeds.'Pune or the 'Queen of Deccan' is known for its educational, research and development institutions. This beautiful city has many exotic locales attracting innumerable tourists.
Jaipur – Jaipur is located in India and attracts a flurry of tourists from all over the world. Sited within eastern Rajasthan, North India, the city of Jaipur is famed for its hilltop fortresses, magnificent royal palaces and historic pink-painted sandstone architecture, earning it the affectionate nickname of the 'Pink City'.
Chennai - Chennai formerly known as Madras is the capital city of the Indian state of Tamil Nadu. It is famous for its culture and tradition. Chennai hosts a large cultural event, which includes performances by hundreds of artists. The city has a vibrant theatre scene and is an important centre for the Bharatanatyam, a classical dance form.
Gurgaon – It is one of the four important satellite cities of the National Capital Region and is often referred to as the 'Millennium City.' Gurgaon has recently emerged as the latest hub for Medical Tourism. Apart from being IT hub and a favorite haunt for MNC offices, the city has a number of world class hospitals that not only treat Indian citizens but also people from outside.
Chandigarh - Chandigarh is a rare epitome of modernization co-existing with nature's preservation. It is here that the trees and plants are as much a part of the construction plans as the buildings and the roads. India’s first planned city, Chandigarh is a rich, prosperous, spic and span, green city rightly called “THE CITY BEAUTIFUL”.
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