The urethra is the long tube that carries urine outside the body. Because men have a much longer urethra than women, it is more common for men to experience urethral damage requiring surgery.
The Yale Medicine Department of Urology offers innovative surgical treatments for men in need of urethral reconstruction, or surgical repair and rerouting of the urinary tract.
How does the urethra become damaged?
Trauma, inflammation or frequent urinary tract infections can lead to a narrowing of one portion of the urethra, causing painful and obstructed urination. This kind of urinary blockage is called stricture, and it sometimes requires surgery.
How is stricture diagnosed?
There are different imaging techniques that can be used to identify stricture. A clinician might use dye and an x-ray to help identify the problem area using a technique called contrast imaging.
In addition, an ultrasound helps to determine the exact stricture length prior to surgery. An endoscope or cystoscope (long, thin medical devices inserted inside the urethra) might also be used to identify the stricture.
How is reconstructive surgery preformed?
Urethral reconstruction is a complex and delicate procedure, requiring several hours in the operating room and recovery time in the hospital.
To repair the urethra, clinicians will first identify the exact size and location of the blockage. Several different surgical procedures might be used depending on the extent of the stricture, the patient’s preferences, and overall health.
Depending on the exact location and the extent of damage, the urethra will be repaired by either replacing the tissue with tissue from another part of the body, or by taking out the damaged portion of the urethra and then reconnecting the urethral tube.
Urethroplasty, surgery to remove the scar tissue, has a long term success rate of 90-95%, and is considered the best option for a long term cure. Alternatively, depending on the extend of damage, a catheter might also be used to expand the narrow opening.
Does Yale Medicine offer other surgical procedures involving the urinary system?
The urinary system, also called the renal system, connects the body’s four major waste management organs.
The kidneys are connected to the bladder via a long tube called the ureter. Once urine is stored in the bladder, it is expelled outside the body through another tube called the urethra. In men, the length of the urethra is much longer than in women.
If surgeons detect blockage in the renal pelvis, they usually perform a relatively straightforward procedure called pyeloplasty, in which the renal pelvis is modified to drain the kidney. If the damage is located in the ureter (connecting the kidney to the bladder), reconstructive surgery might include borrowing tissue from the bladder or bowel to support repair of the ureter.
In many cases, a condition called neurogenic urinary bladder prompts reconstructive surgery of the bladder. If the bladder cannot hold enough water, or has too much pressure, reconstruction might also be needed. Bladder reconstruction is more complex and will depend on the extent of the damaged tissue. If damage is minimal, the patient’s own abdominal tissue will likely be used to reconstruct the bladder.
If damage is more extensive, and the bladder needs to be removed, urine may have to be diverted outside the body. Our surgeons are experts in reconstructive methods typically employed in bladder reconstruction, including procedures that do not require the patient to wear an external bag to hold urine.