Failed Urethroplasty treatment by one of the best Reconstructive Urologists. Urethra is one of the most vital parts of the body, thatregulates the excretion of urine from the body. In men, urethra also forms the passage for the ejaculation of sperms. However, this thin, fibro-muscular tube could also be easily ruptured, causing severe pain. In most of the cases, urethroplasty serves as the best course of action if there is any injury or defect inside the urethra.
What is failed urethroplasty
Failed Urethroplasty is a surgical procedure to treat any rupture inside the walls of urethra. These ruptures could be caused due to trauma, infections or physical injuries. Urethroplasty is considered to be the go-to medical procedure, since the success rate in urethroplasty is quite high.
During urethroplasty, the urethra is reconstructed via surgical procedure and using a urethral catheter. This catheter is left inside the urethra for few weeks, during which time urethra is completely healed.
Types of urethroplasty
Based upon multiple factors (like the physical condition of patient, severity of defect, status of urethra etc.) there are generally 4 types of urethroplasty:
1) Anastomotic urethroplasty
This is a single-stage surgery, where the urethra is envisioned (in the range of the deformity), and the cut is made at its mid-line (as a rule), utilizing a bovie blade to dissect both the dermal as well as sub-dermal layers until the related musculature, corpus cavernosum, ventral urethral perspectives and corpus spongiosum are uncovered. Specific care is provided amidst the procedure to avoid any harm to nerves and veins (which could become a cause of erectile dysfunction or loss of penile sensitivity).
This technique is quite successful, with a rate of success over 95%. Anastomotic urethroplasty is viewed as the “best quality level” of surgical repair alternatives, since it is comparatively easier with high success rate.
2) Buccal mucosal onlay graft
In this technique, the range of the defect is assessed and marked horizontally mid-line, and the sutures are situated (one, each) at the proximal and distal closures of the zone of urethra nearest to fringe of the blemished territory. At the same time, a urological specialist who is expert in buccal mucosal gathering systems will start to collect and repair a segment within cheek of the patient, relative to the measurement/shape ascertained and asked for by the specialist performing the urethral part of the methodology.
With a high success rate of 87-98%, buccal mucosal onlay urethroplasty is viewed as the best of repair alternatives for strictures larger than 2 cm long.
3) Scrotal/penile island graft
This type of surgery is carried out in male patients. A scrotal graft (or, in some cases, a penile island flap) is sutured in the location, fixed with firbin glue to prevent any leakages. The whole process is carried out using micro surgical techniques. Due to high complexity, this type of urethroplasty has a success rate of 70-85%, thus making is not an attractive choice. However, in cases of strictures larger than 4cm, it could be opted for.
4) Johansen’s urethroplasty
This complex urethroplasty involves opening the urethra ventrally, while a skin strip (usually created from scrotum) is buried inside for the repair. Due to its high complexity, only a few cases have ever opted for this, thereby making no data for success rate available.
Even though urethroplasty is the benchmark for any treatment of urethra, it is not completely successful. Severe complications might occur in up to 12% of the cases, while minor ones might be as high as 40%. Let’ take a look at some of the causes of failed urethroplasty:
- The major cause for failure in case of anastomotic urethroplasty was the inadequate excision of the wound at the top of prostatic urethra. Surgery in case of scars around the urethra often leads to failures. Other causesincludeischemia and tension hematoma. In general, defects that have existed for a longer time have higher chances of having a failed urethroplasty.
- In case of buccal mucosal onlay graft, the success rate is generally better. The main causes include formation of proximal anastomotic ring or distal anastomotic ring, or the loss of entire graft. In presence of these factors, BMG urethroplasty is generally discouraged. However, in other cases, it gives excellent results.
- The length of strictures directly affects the success of any urethroplasty. In almost every case, stricture with greater length at a higher risk factor associated with them.
- As opposed to popular notion, the size of defect has almost no impact upon the success of the surgery. Likewise, the patients’history of previous urethroplasty has no importantinfluence on the outcome of the current operation.
Statistically, the chances of the urethroplasty getting failed are quite low. In case of BMG urethroplasty, for example, there is less than 3% chance that any significant complication would arise. However, no matter how small, the chances of a failed urethroplasty always persists. The complications that arise are generally minor ones. Some of such post-surgical complications are:
- The stricture may not be completely eliminated, and might return after surgery.
- The patient might suffer from urinary incontinence, which is the involuntary leakage of urine. This complication is more common in women.
- The patient could suffer from erectile dysfunction. In most cases, this is a temporary post-surgery symptom, but sometime it could become a severe condition in itself.
- Urinary retention is also a common complication, where the patient might not be able to completely empty the bladder even after many attempts. Due to this, the patient might get the urge to urinate frequently.
- Retrograde ejaculation is a less common, but more severe complication. In this case, the patient is unable to ejaculate the semen via urethra, which instead gets deposited in the urinary bladder. This is not a symptom and must be treated immediately.
- Bleeding from both external and internal sature lines.
Urethroplasty is one of the most popular courses of actions in case of ruptured or infected urethra. Countless patients, with their success stories, have popularized this surgery among people and doctors alike. However, failed urethroplasty is not unheard of, and the factors that contribute to them must be kept in mind. Patients must be aware of the complications that might arise in case of urethroplasty procedure those are not successful, and what must be done in that case.
To know more please contact :
Dr. Gautam Banga
Urologist, Andrologist and Genito -Urinary Reconstructive Surgeon
Contact no. : +91-9999062316