Urethroplasty in Men: Frequently Asked Questions

What Is a Urethral Stricture?

Urine produced by the kidneys collects in the bladder and leaves the body through a tube called the urethra. In some people, part of this tube becomes narrower over time. This is known as a urethral stricture.

When the urethra narrows, urine cannot flow out easily. The most common symptoms include a weak urinary stream, a split stream or dribbling, a feeling that the bladder has not emptied completely after urinating, frequent urination, and recurrent urinary tract infections. Over time, the strain can affect the bladder, and in advanced cases, the kidneys may also be at risk.

What causes a stricture? Common causes include previous urinary tract infections, urinary catheterisation or endoscopic procedures, and injuries to the area, such as those caused by a fall or accident. In some patients, no clear cause can be identified despite thorough investigation. This is fairly common and is not, in itself, a cause for concern.

There are several ways to treat a urethral stricture. Endoscopic procedures, such as widening the urethra from within, may provide short-term relief, but the narrowing often returns after these treatments. Urethral reconstruction surgery (urethroplasty) aims to provide a lasting solution by directly repairing the narrowed section and is therefore considered the most effective option for definitive treatment.

Below, you will find answers to the questions our patients most frequently ask about this operation.

Before Surgery

What tests will I need before surgery?

Before planning the operation, your surgeon needs to know where the stricture is, how long it is, and how many areas are affected. Three investigations are commonly used: a urine flow test (uroflowmetry) measures the strength of your urinary stream; a retrograde urethrogram involves introducing contrast fluid into the urethra and taking X-rays to clearly show the location of the narrowing; and, if necessary, cystoscopy is performed to examine the urethra with a small camera.

These tests are essential because they determine how the operation will be performed. Both the decision to operate and the choice of surgical technique are finalised after these investigations.

How long does the operation take?

This depends on the length of the stricture and the technique used. The operation usually takes between 2 and 4 hours. Longer strictures requiring a tissue graft may take closer to the upper end of this range.

Will I have general or spinal anaesthesia?

This is a common question and a topic that is often misunderstood. The operation is usually performed under general anaesthesia, meaning you will be asleep and will not hear or feel anything during surgery.

The reason is that the tissue graft used for longer strictures is taken from inside your mouth, usually the inner cheek, during the same operation. When surgery involves the inside of the mouth, spinal anaesthesia alone is not sufficient or safe. General anaesthesia allows the surgeon to work safely and comfortably on both the mouth and the urethra.

How long will I stay in hospital?

For most patients, a hospital stay of 3–4 days is sufficient. Your pain and general condition will be assessed on the day after surgery. If there are no problems, you will be discharged with your catheter still in place.

Do I need to stop taking my medication before surgery?

If you take blood-thinning medication, it may need to be adjusted under medical supervision for a specified period before the operation. Do not stop or start any medication on your own. At your preoperative consultation, tell your doctor about all medicines you take, including herbal supplements.

What Happens During Surgery?

How is the surgical technique chosen?

The choice depends on the length and location of the stricture. If the stricture is short, the narrowed section is removed and the two healthy ends of the urethra are stitched together. If the stricture is long, the urethra is widened and a tissue graft is added, rather than removing the entire affected section. In simple terms, short strictures are treated by removing the narrowing and joining the ends, while longer strictures are treated by widening the urethra with a graft.

Where is the tissue graft taken from?

For longer strictures, the graft is most commonly taken from the lining of the mouth, usually the inner cheek (a buccal mucosal graft). This tissue is flexible, adapted to a moist environment, and well suited to the urethra. These qualities make it the preferred tissue for this type of reconstruction.

Will taking tissue from my mouth cause lasting problems?

No. During the first few days, the area where the tissue was taken may feel tender, slightly swollen, or uncomfortable when speaking or eating. These symptoms usually settle quickly. The lining of the mouth heals very rapidly, and lasting problems with speech or chewing are generally not expected.

Will I have a catheter after surgery?

Yes. A urinary catheter is placed in the urethra at the end of the operation. Its purpose is to divert urine away from the newly repaired area and give the tissue time to heal. The catheter will remain in place for a period after you go home.

Recovery After Surgery

How long will the catheter stay in place?

This is one of the most frequently asked questions and one of the most important points to understand. The duration depends on the length of the stricture and whether a tissue graft is used. After reconstruction using a graft taken from inside the mouth, the catheter usually stays in place for 3–4 weeks. This time is needed for the graft to become securely established in its new position.

The catheter may be removed sooner after surgery for a short stricture in which the two ends of the urethra are joined together. The duration is therefore not the same for every patient; your doctor will give you a specific timeframe based on your situation.

What will everyday life be like with a catheter?

You can continue most everyday activities, including walking, light household tasks, and desk work. You are advised to drink plenty of water, keep the drainage bag below bladder level, and keep the catheter area clean.

Contact your doctor without delay if you develop a fever, urine leaks around the catheter, the catheter stops draining, you experience severe pain, or your urine becomes noticeably cloudy or foul-smelling.

Will I have pain?

Some pain is normal during the first few days. It can usually be managed effectively with the painkillers prescribed for you. Your need for pain relief will decrease over time, and most patients feel noticeably better by the end of the first week.

When can I return to work?

Patients with desk jobs can usually return to work within 4 weeks. A longer recovery period is recommended for work involving heavy lifting, extensive walking, or activities such as cycling that put pressure on the surgical area.

When can I exercise again?

You can start gentle walking early in your recovery. Your doctor will advise you on the exact timing at your follow-up appointment.

When can I resume sexual activity?

You can usually resume sexual activity a few weeks after the catheter has been removed, once the tissue has healed and your doctor has given you the go-ahead. It is best to allow time for healing rather than rush. Do not hesitate to raise any questions at your follow-up appointment.

Success Rates and Follow-Up

What is the success rate of the operation?

The long-term success rate is high when the appropriate technique is used for the right patient. However, outcomes vary: the length and location of the stricture, as well as the number of previous procedures, can affect the result.

Are there factors that affect the success of surgery?

Yes. Surgery becomes technically more challenging as the stricture becomes longer and the number of previous unsuccessful procedures increases. Smoking and poorly controlled blood sugar also slow wound healing. Stopping smoking before surgery, where possible, and bringing blood sugar under control if you have diabetes can therefore make a significant contribution to recovery.

What happens if the stricture returns?

There is no need to panic. If the stricture recurs, the first step is a reassessment. Depending on the findings, an endoscopic procedure may be sufficient, or a second reconstructive operation may be planned.

Do I need to attend follow-up appointments?

Yes, this is very important. After surgery, urine flow is measured at regular intervals—usually at 3, 6, and 12 months, and then once a year—to check that the urethra remains open. Attending these appointments, even if you have no symptoms, helps detect any recurrent narrowing early.

What happens if I do not have surgery?

A urethral stricture does not resolve on its own. Without treatment, difficulty passing urine continues. Over time, the strain can weaken the bladder, infections may become more frequent because the bladder does not empty completely, and the kidneys may be affected in advanced cases. Even if your symptoms seem manageable, monitoring the stricture and arranging treatment at the appropriate time are recommended.

Will my urinary stream be strong again after surgery?

That is precisely the aim. When the repair is successful, most patients notice a significant improvement in their urinary stream shortly after the catheter is removed. There may be some burning or mild difficulty passing urine during the first few days, but this is usually temporary.

Will I have a visible scar?

The incision is made in the area between the legs, so the scar is not normally visible. The site inside the mouth where the graft was taken also heals over time and is not visible from the outside.

Is this a risky operation?

As with any operation, there are general risks, including bleeding, infection, and wound-healing problems. However, urethroplasty is a planned reconstructive procedure routinely performed at experienced centres. Your individual risks will be explained in detail at your preoperative consultation, based on your medical history and the characteristics of your stricture.

Will I have urinary incontinence after surgery?

The operation treats the urethra itself rather than the muscles responsible for urinary control. The risk of urinary incontinence is therefore generally low. Rarely, particularly with more complex or recurrent strictures, temporary difficulty controlling urination may occur; this usually improves over time.

Common Misconceptions

“It is a simple procedure, and everything will return to normal straight away.” Even when the operation is successful, the tissue takes weeks to heal. Not following instructions about catheter duration and activity restrictions may increase the risk of the stricture returning.

“Taking tissue from my mouth will affect my speech.” The lining of the mouth heals quickly, and lasting problems with speech or chewing are generally not expected.

“If the operation is successful, follow-up appointments are unnecessary.” A stricture can recur even years later. Regular follow-up is recommended even if you have no symptoms.

Questions to Ask Your Doctor

Do not hesitate to ask the following questions during your consultation: Which technique is suitable for my stricture? Will a tissue graft be used? How many weeks will my catheter stay in place? When can I return to work and exercise? How often will I need follow-up appointments?

Brief Summary

• A urethral stricture is a narrowing of the tube through which urine leaves the body; the most typical symptom is a weak urinary stream.

• Endoscopic procedures generally provide temporary relief; urethral reconstruction surgery (urethroplasty) is performed to provide a lasting solution.

• The surgical plan is finalised after investigations such as a urine flow test and a urethrogram.

• Because a tissue graft is taken from inside the mouth, the operation is usually performed under general anaesthesia.

• After graft-based reconstruction, the catheter usually remains in place for 3–4 weeks.

• Patients can return to desk work 2–4 weeks after catheter removal and to physically demanding work after 8–10 weeks.

• Attending regular follow-up appointments, even without symptoms, helps detect any recurrence early.