The highly skilled and experienced doctors at Cedars-Sinai Marina del Rey Hospital will decide the best option for treating your condition. If a urethroplasty is required, rest assured that the procedure will be performed by the best urologists in Los Angeles using the latest techniques developed for treating similar afflictions. At Cedars-Sinai Marina del Rey Hospital we are proud to have the best personnel specialized in minimally invasive surgery, assuring you of a safer procedure with better results – less pain, less scarring, and a much faster recovery.
Urethroplasty is a surgical procedure that is performed to remove the ureteral strictures. Scar tissue formation may occur in the ureter following an accident, surgery, or because of a condition such as endometriosis or cancer. The scar tissue narrows down the ureter. As a result, urine does not flow down the ureter and gets collected in the kidney causing pain. It may also lead to urinary tract and kidney infection.
Urethroplasty may be performed through two approaches:
- Laparoscopy: In this technique, several tiny incisions are made in the abdomen.
- Open surgery: A single larger incision is made in the abdomen or on the side over the ribs. The surgeon can see the visceral organs and work directly through this incision.
However, laparoscopy is not suitable in all cases. Sometimes, surgery that begins with laparoscopy may change to open surgery for safety considerations. Your surgeon will decide the best option for your condition.
Your surgeon will advise you on certain precautions to be followed before undergoing urethroplasty. In addition, you need to follow general guidelines such as:
- You may need to discontinue some medications before surgery. Let your surgeon know if you are on anticoagulant medicines such as warfarin, clopidogrel, or regular aspirin.
- You should stop eating or drinking for at least 8 hours before your surgery. If you have been advised to take any medicine, you can do so with only a small sip of water.
- You may be prescribed a medicine to be taken on the previous day of the surgery. Please take it compulsorily as it ensures your colon is empty before surgery.
Typically, urethroplasty lasts for about 2 to 4 hours. You will be administered general anesthesia, which keeps you comfortable during the surgery. Epidural anesthesia may also be given to numb the lower portion of your body and for postoperative pain. Then, a catheter is inserted into the bladder through the ureter to drain out the urine during the surgery. The constricted part of the ureter is cut, and if a larger section is removed, the tissue is utilized to repair the ureter. The tissue may also be taken from other parts of the body such as the bladder. The cut ends of the ureter are then rejoined with absorbable sutures.
A flexible tube called a stent is passed into the ureter and kept there for 4-6 weeks after surgery to facilitate healing of the repaired ureter. The incision is then closed using sutures, staples, or surgical glue, leaving one or more tubes or drains to prevent fluid buildup after surgery.
The surgeon makes several small incisions in the abdomen for this technique. Through one of these small incisions, the laparoscope is passed. The scope transmits images of the inside of the abdomen to a video screen. The surgical instruments are passed through the remaining incisions.
The surgeon may also use a technique called robotic laparoscopy. In this, the robotic system enables a 3-D view of the inner parts of the body. It also assists in translating the surgeon's hand movements. The da Vinci® Surgical System is an advanced robotic platform specifically designed to extend the surgeon's capabilities. It offers state-of-the-art minimally invasive facilities for any major surgery.
Urethroplasty helps in relieving the symptoms that occur as a result of the ureteral stricture. With minimally invasive urethroplasty, the difference lies in the patient's recovery.
A laparoscopic urethroplasty requires only a few tiny incisions as compared to a traditional open surgery, which is done through a larger incision.
With robotic surgery, the da Vinci Si surgical robot heightens the surgeon's inherent steadiness and precision, resulting in more accurate incisions.
Other advantages of minimally invasive surgical treatment are:
- Minimal scarring
- Lesser postoperative pain
- Minimal risk of infection and other side effects
- Shorter hospital stay
As with any major surgery, there could be risks and complications associated with a urethroplasty procedure. These include:
The time required to achieve complete recovery and return to normal routine activities may vary among individuals. These instructions need to be followed until you recover:
- Take all the prescribed medications as directed by the surgeon
- Avoid lifting heavy objects and strenuous activities
- Avoid straining during bowel movement; instead, take stool softeners if needed.
- Avoid driving when you are taking prescription pain medications.
- Avoid swimming, bathing, and other activities during which the incision may come in contact with water.
Immediately seek medical attention if you come across the following problems:
- Chest pain or difficulty breathing
- Fever, 100.4°F or higher
- Increased redness or swelling, warmth, increased pain, or foul-smelling discharge at the incision site
- Pain in the abdomen that does not get relieved from taking pain medicines
- Presence of blood clots in the urine
- Swollen legs
- Recurrent vomiting
- Trouble with urination