TürkçeUrethroplasty is the definitive and permanent repair of urinary tract obstructions known as urethral strictures, performed according to the principles of plastic surgery. This surgical intervention restores the natural pressure of urinary flow by reconstructing the narrowed or nonfunctional section of the urinary canal with healthy tissues. Unlike endoscopic methods, this operation offers a definitive solution in chronic strictures and restores the anatomical integrity of the canal by using tissue grafting and microsurgical techniques. This functional reconstruction process, which directly affects quality of life, is based on replacing hardened scar tissue in the urinary tract with flexible and living tissues.
| What Is Urethroplasty? | Urethroplasty is the surgical repair or reconstruction of damage to the urethra caused by congenital anomalies, trauma, infection, previous surgeries, or conditions such as urethral stricture. |
| Purpose | Its purpose is to enable normal urinary flow, eliminate difficulty urinating, reduce recurrent infections, and improve quality of life. |
| Who Can Undergo It? | It may be performed in individuals who require urethral reconstruction due to urethral stricture, traumatic urethral injuries, hypospadias complications, certain congenital anomalies, or as part of gender-affirming surgery. |
| Main Indications | Urethral stricture, recurrent strictures, marked reduction in urinary flow, complete urethral injury, fistulas, and conditions requiring complex urethral reconstruction. |
| Preoperative Evaluation | Evaluation may include medical history, physical examination, urinalysis, uroflowmetry, cystoscopy, retrograde urethrography, and other imaging methods when necessary. |
| Surgical Techniques | Depending on the length, location, and cause of the stricture, end-to-end anastomosis, graft urethroplasty, flap urethroplasty, or staged reconstruction techniques may be applied. |
| Use of Grafts | When necessary, inner cheek mucosa from the mouth (buccal mucosa), tongue mucosa, or other suitable tissues may be used as grafts. Buccal mucosa is one of the most frequently preferred grafts. |
| Use of Flaps | In some patients, the urethra may be reconstructed using local tissue flaps with preserved blood supply. |
| Its Role in Gender-Affirming Surgery | During metoidioplasty or phalloplasty, urethroplasty may be performed to extend the urethra to the newly created penis and allow urination from the tip. |
| Anesthesia | It is generally performed under general anesthesia. Different anesthesia methods may be preferred in some cases. |
| Surgery Duration | Although it varies depending on the technique applied and the scope of reconstruction, it may generally take several hours. |
| Hospital Stay | Depending on the scope of the surgery, same-day discharge or a hospital stay of several days may be required. |
| Urinary Catheter | A urinary catheter is generally used for a specific period after surgery to support the healing of the repair. |
| Recovery Process | While initial recovery occurs within a few weeks, complete tissue healing and evaluation of functional results may take months. |
| Success Rate | Although the success rate varies according to the cause and length of the stricture, the technique used, and patient-related factors, high success may be achieved in many cases at experienced centers. |
| Possible Risks | Bleeding, infection, wound-healing problems, recurrence of the stricture, urethral fistula, urinary incontinence, difficulty urinating, and the need for additional surgery may develop. |
| Urethral Fistula | It is a condition in which urine exits through a different opening due to the formation of an unwanted channel between the urethra and the skin, and it may require additional treatment. |
| Recurrence of the Stricture | Some patients may develop another urethral stricture over time and may require an additional intervention. |
| Postoperative Care | Catheter care, wound care, adequate fluid intake, avoiding strenuous physical activities, and regular medical follow-ups are important. |
| Return to Daily Life | The return period varies according to the scope of the surgery performed and the individual’s recovery rate. Following the doctor’s recommendations is important for recovery. |
| Follow-Up | During regular follow-ups, urinary flow, wound healing, possible complications, and long-term functional results are evaluated. |
| Expected Result | After successful urethroplasty, the aim is to improve urinary flow, reduce symptoms, and preserve the long-term function of the urethra. Results may vary according to the characteristics of the disease and the surgical technique applied. |
What Is Urethroplasty?
Urethroplasty is a surgical method that provides permanent treatment for obstructions occurring in the urinary canal, medically known as urethral stricture. The urinary tract in our body is lined with a flexible and highly delicate mucosal layer. When this mucosal layer is damaged for various reasons, the body forms scar tissue to repair the area. However, this scar tissue inside the canal is not flexible like normal tissue; it is hard and tends to contract. As it contracts, it begins to narrow the lumen through which urine passes.
Forcing this narrowing open with endoscopic surgeries or catheters often provides only temporary relief because the body perceives that force as new trauma and responds by forming thicker scar tissue. Urethroplasty is designed to break this vicious cycle. The purpose of this surgery is not merely to open a hole but to remove the hardened and diseased tissue completely or repair the area by widening it with new, flexible, healthy tissues. In this way, the urinary tract regains a width and function similar to its natural structure before the damage occurred.
What Causes Urethral Stricture and How Does the Need for Urethroplasty Arise?
Narrowing in the urinary canal is generally the result of an event that occurred in the past and becomes apparent months or sometimes even years later. Although the urinary tract is located in a relatively protected area, certain external or internal factors may disrupt the integrity of this canal. Scars that form during the healing phase of these injuries may thicken over time and begin to create a physical obstruction to urinary flow. Even the effects of a simple operation performed during childhood may sometimes appear as a stricture in adulthood.
The main factors that predispose a person to this condition are highly varied. Mechanical trauma or inflammatory processes are generally the primary causes of these narrowings. Knowing the conditions that cause tissues to react in this way is of great importance in understanding the source of the problem.
Common causes of urethral stricture include:
- Traffic accidents
- Falls from a height
- Bicycle accidents
- Long-term catheter use
- Previous prostate surgeries
- Urinary tract infections
- Sexually transmitted diseases
- Lichen sclerosus
- Congenital anatomical problems
What Are the Symptoms That Require Urethroplasty Surgery?
When narrowing begins in the urinary canal, the body initially tries to tolerate the condition. The bladder increases pressure by contracting its muscles more forcefully to expel urine through the narrow passage. However, as the stricture progresses, the bladder’s strength begins to become insufficient, and complaints that make daily life considerably more difficult emerge. Patients generally notice that they spend much longer in the bathroom than before and cannot empty their urine comfortably.
Because this process progresses slowly, people may sometimes become accustomed to it and assume that it is a natural consequence of aging. However, physical changes in urinary flow are among the clearest signals of an anatomical deterioration within the canal. When these signals are ignored, urine accumulating in the urinary tract creates a favorable environment for infections that may extend to the kidneys.
The most common symptoms experienced by patients are as follows:
- Difficulty urinating
- Weak urinary stream
- Split urinary stream
- Burning during urination
- Frequent urination
- Dribbling urination
- Feeling of incomplete bladder emptying
- Recurrent urinary tract infections
What Preparations Are Made Before Urethroplasty?
Before deciding on surgery, it is necessary to map where the problem is located and how large an area it covers. This is because the location of the stricture along the length of the urinary canal completely changes the surgical technique to be applied. Therefore, the preoperative preparation process is carried out with at least as much care as the surgery itself. After the patient’s general health condition is evaluated, specific tests aimed at visualizing the anatomy of the urinary tract are performed.
First, tests that measure urinary flow rate and show how much the bladder is being strained are conducted. Then, a special contrast agent is introduced into the urinary canal and X-rays are taken. These images clearly reveal where the obstruction is located in the urinary canal, the exact length of the stricture in millimeters, and the condition of the remaining healthy tissue. In light of all this information, the most suitable and completely personalized surgical plan is created for the patient.
How Is Urethroplasty Surgery Performed?
Urethroplasty is performed under general anesthesia or spinal anesthesia, which numbs the lower body, in a fully equipped operating room, depending on the patient’s condition. The basic principle of the procedure is to access the problematic area externally, expose the urinary canal, and repair the narrowed section. This repair process is directly related to the location and length of the stricture. Sometimes the procedure is performed over an area of only a few centimeters, while at other times a much longer portion of the canal must be reconstructed.
During surgery, the surgeon reaches the area of the stricture with extremely delicate maneuvers. The aim is to intervene only in the problematic urinary canal without causing any damage to the surrounding tissues, especially the nerves and muscles responsible for sexual functions and urinary continence. When the hardened scar tissue that has narrowed and lost its elasticity is identified, it is either completely cut out and removed or the canal is opened lengthwise and a new tissue patch is added, depending on what the condition requires. After the procedure is completed, a silicone catheter is placed in the urinary tract so that the newly created internal structure can heal and urine does not damage the sutures, and the operation is concluded.
Which Surgical Methods Are Used in Urethroplasty Surgery?
The method of repair depends entirely on the characteristics of the stricture. If the stricture is very short and located in a specific section of the canal, the end-to-end joining method provides highly successful results. In this method, the hardened narrowed section is completely cut out and removed like a cylinder. The two remaining healthy ends with good blood supply are joined together using extremely fine sutures in accordance with microsurgical principles. In this way, the narrowed portion of the canal is completely eliminated, and the urinary tract is reconnected at its former healthy width.
However, if the stricture is long, cutting out the diseased tissue would shorten the canal too much, create tension, and prevent the sutures from holding. In such cases, patching with tissues taken from another part of the body is used. The narrowed canal is cut lengthwise and opened like a book, and flexible tissue brought from another area is sutured into the narrow section to widen the diameter of the canal. You can think of it like adding fabric to a garment that is too tight to make it wider. In this way, even long strictures can be treated successfully without creating tension.
Why Is Oral Tissue Preferred for Urethroplasty?
When the patch method is used, finding tissue that will adapt best to the urinary canal is vital. As a result of years of medical development, it has been discovered that the most ideal material in the human body for this purpose is the oral mucosa, particularly the inner lining of the cheeks. The structure of the inside of the mouth, just like the urinary tract, is designed to remain constantly wet and moist. Therefore, when tissue taken from there is transplanted into the wet environment of the urinary canal, it does not experience incompatibility and immediately adapts to the area.
In addition, oral tissue is extremely flexible, has a very rich underlying vascular network, and possesses an exceptionally high healing capacity. When a thin piece of tissue taken from the inner cheek is sutured into the urinary tract, it rapidly forms new connections with the surrounding blood vessels and maintains its vitality. Moreover, the area inside the mouth from which the tissue is taken completely heals on its own within only a few days without requiring any sutures and leaves no scar.
The reasons why oral tissue is preferred include:
- Adaptation to a wet environment
- High flexibility
- Rapid vascularization
- Resistance to urinary acidity
- Easy accessibility
- No scarring inside the mouth
Recovery Process After Urethroplasty
After the operation is completed, the body’s self-repair process begins. This period is at least as critical as the surgery itself for the perfectly performed operation to produce results. It takes a certain amount of time for the newly created suture lines to heal and, if a graft has been used, for that graft to fully adhere by establishing vascular connections with the underlying tissues. During the first few days, the body attempts to eliminate the edema caused by the operation. At this stage, it is very important for the patient to rest and keep the surgical area as immobile as possible.
In the following days, new capillaries begin to form in the areas where the graft was applied. These new vessels attach to the underlying surface of the urinary canal like plant roots taking hold in soil and begin to carry blood to the graft. The vascularized tissue turns pink, becomes viable, and transforms into a natural part of the urinary tract. This process of biological integration progresses very quietly yet powerfully. The body not only heals the wound in that area but also transforms it into a structure flexible and strong enough to withstand the new urinary pressure.
When Is the Catheter Removed After Urethroplasty?
The silicone catheter placed in the urinary canal at the end of the operation is one of the greatest heroes of the recovery process. You can think of this catheter like a cast placed on a broken arm. Allowing urine to pass immediately through the delicate and newly repaired tissues inside would both damage the sutures and create a risk of infection. The catheter carries urine directly from the bladder to the outside without allowing it to touch the newly reconstructed area. At the same time, it serves as a type of mold for the new canal, allowing it to heal in a cylindrical shape without narrowing.
The catheter generally remains in place for several weeks, depending on the extent of the surgery performed. At the end of this period, a small imaging study is carried out by introducing a colored liquid immediately before removing the catheter to ensure that the sutures have healed. If the image shows no leakage outside the urinary canal, healing is confirmed, and the catheter is removed completely painlessly within a few seconds. From that moment onward, the patient experiences the relief of being able to urinate normally, forcefully, and comfortably.
What Should People Who Have Undergone Urethroplasty Pay Attention To?
The weeks after discharge and returning home are a delicate period during which the newly established system must be protected. Even if the internal tissues appear to have healed, it takes months for them to regain their former full strength. For this reason, patients must make small but highly effective changes in their daily lives and protect the surgical area carefully from mechanical trauma. Avoiding all movements that place pressure on the perineal area is the golden rule of this process.
During the period when the catheter is in place, it is very important to pay careful attention to catheter care, always keep the urine bag below waist level, and prevent the tubing from becoming stretched or accidentally pulled. In addition, during this period, the immune system should be supported and sufficient time should be devoted to rest so that the body can fight infections and the sutures are not strained. Simple precautions directly safeguard the success of this major and valuable surgery.
Some physical activities that should be avoided include:
- Riding a bicycle
- Riding a motorcycle
- Horseback riding
- Lifting heavy objects
- Straining
- Sitting on hard surfaces
When Can Sexual Activity Be Resumed After Urethroplasty?
Sexual activity after surgery is one of the subjects patients are most curious about. By its nature, urethroplasty is an operation that also aims to preserve sexual functions and is designed not to damage erection and ejaculation functions. However, sexual abstinence is essential during the recovery process. During an erection, blood pressure inside the penis rises suddenly and the tissues expand. This expansion may cause serious tension in the newly sutured urinary canal.
This tension may cause the sutures to separate, internal bleeding to begin, or the graft to shift from its position. Therefore, sexual intercourse and masturbation must be strictly avoided for the period determined after surgery, which generally lasts several months. After this rest period has passed and the doctor has given approval, it is possible to return to a completely normal sexual life and even a healthier one than before because the previous problems caused by the stricture have been eliminated.
What Should the Diet Be Like After Urethroplasty?
During the recovery period, nutrition not only provides energy but also serves as a therapeutic tool that accelerates wound healing and reduces the physical stress placed on the surgical area. Our greatest enemy during this period is constipation. Straining in the bathroom because of constipation creates very high pressure in the pelvic floor muscles and consequently in the surgical area. This pressure places tremendous stress on the sutures. Therefore, a fiber-rich diet that keeps the digestive system as comfortable and soft as possible should be adopted.
In addition, consuming plenty of fluids is indispensable for continuously flushing the urinary tract from within, diluting the urine to reduce its acidic burning effect, and preventing infections. In cases where a graft is taken from inside the mouth, maximum attention should also be paid to oral hygiene, and soft, non-acidic foods should be preferred. The right foods support cellular regeneration and allow the patient to feel much more energetic.
The following should be emphasized in the diet:
- Water
- High-fiber foods
- Fresh vegetables
- Juicy fruits
- Whole grains
- Meals prepared with olive oil
- Soups
In Which Emergencies Should a Doctor Be Consulted After Urethroplasty?
During the resting period at home, everything generally progresses well and no serious problems are encountered. Minor leakage, slightly pink urine, or vague pain in the surgical area are natural parts of recovery. However, the body may not always react as expected, and unexpected situations may sometimes occur. It is very important for patients to listen to their bodies and correctly recognize certain warning signs that deviate from normal.
Especially when there is a systemic infection or mechanical obstruction, losing time may worsen the problem. In cases of increased pressure that may endanger the surgical area or a risk of infection spreading into the bloodstream, it is vital for the patient to contact the team that performed the operation immediately instead of waiting at home or attempting to resolve the issue independently. Early intervention always prevents more serious complications.
Situations requiring immediate medical attention include:
- High fever
- Severe chills
- Inability to urinate
- Large amounts of fresh bleeding
- Catheter blockage
- Accidental catheter removal
- Foul-smelling discharge
- Sudden and unbearable pain
What Affects the Success Rate of Urethroplasty Surgery?
When planned correctly and performed by experienced hands, urethroplasty is a permanent treatment with an extremely high success rate. However, this success does not depend on a single factor; it is shaped by the combination of many components. The length of the stricture, the section of the urinary canal where it is located, and how many endoscopic or open interventions have previously been performed in that area directly affect the course of the operation. In a urinary canal that has undergone numerous endoscopic surgeries, the tissues may become so damaged that finding a healthy foundation becomes difficult.
In addition, technical details such as the microsurgical precision shown by the surgeon while handling the tissue and suturing the graft in the correct position with the appropriate tension are at the heart of success. However, another equally important factor that should not be forgotten is the patient. Smoking slows tissue healing and the formation of new blood vessels dramatically and increases the risk that the graft will fail to take. Keeping the patient’s chronic conditions, such as diabetes, under control and following the postoperative protection rules exactly are factors that help ensure this surgery remains a lifelong solution.
What Should Be Done to Maintain the Long-Term Results of Urethroplasty Treatment?
Completely overcoming the problem of urinary stricture is possible when the patient adapts to a new lifestyle routine after successful surgery. Even after the recovery period has ended, it should not be forgotten that the area has undergone repair. Healthy nutrition, abundant fluid intake, and a lifestyle that does not strain the urinary tract help preserve the flexibility of the urinary canal for many years.
Simple urinary flow tests performed at the intervals determined by your doctor after surgery are the best indicator of whether everything is progressing properly internally. If any weakening in urinary flow is noticed, it should not be postponed, and the patient should remain an observer of their own body from the beginning to the end of the process. Urethroplasty is not only a physical repair but also a permanent process of renewal that restores quality of life and self-confidence by freeing the patient from distressing urinary difficulties.
Frequently Asked Questions
Urethroplasty is the surgical repair of strictures in the urethral canal that carries urine from the bladder to the outside. It is especially preferred for long, recurrent strictures or urethral strictures that do not respond to endoscopic treatments.
Patients with frequently recurring urethral strictures, severe difficulty urinating, or no lasting benefit from previously performed interventions may be among the suitable candidates for urethroplasty.
Weak urinary flow, split urinary stream, frequent urination, a feeling of incomplete bladder emptying, urinary tract infections, and difficulty urinating are among the common symptoms of urethral stricture.
During surgery, the location and length of the stricture are evaluated. The narrowed segment may be removed, or the urethra may be reconstructed using tissues such as oral mucosa. The surgical technique is determined according to the patient.
Mucosal tissue taken from inside the mouth is frequently preferred because of its durable structure and properties compatible with the urethra. This method may provide successful results, particularly in the repair of long-segment strictures.
Urethroplasty is one of the most successful methods for treating urethral stricture when appropriate patient selection is made. The success rate may vary according to the length and location of the stricture and the surgical technique applied.
A urinary catheter is used for a specific period after surgery to ensure that healing progresses properly. The duration of catheter use may vary according to the surgical method applied and the scope of the repair.
Bleeding, infection, wound-healing problems, urinary leakage, and recurrence of the stricture are among the possible complications. Risk rates may vary according to the patient’s health condition and the surgical technique.
Initial recovery generally occurs within a few weeks. However, a longer follow-up period may be required for complete tissue healing and evaluation of urinary functions. Medical follow-ups are important during this period.
Although urethroplasty may provide successful long-term results, the stricture may develop again in some patients. Regular follow-ups and early intervention play an important role in managing possible recurrence.
He completed his medical education at Ankara University Faculty of Medicine in 1996 and his specialty training between 1996–2002 at Hacettepe University Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery.
Between 2002–2009, he worked at Süleyman Demirel University Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery.
Since 2009, he has been working at Hacettepe University Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery. He received the title of Associate Professor in 2011. Dr. Nasır became a Professor in 2019 and continues to work as a faculty member in this position.
Between 2006–2008, he conducted studies on composite tissue transplantation at the Cleveland Clinic in Ohio, USA, together with Dr. Siemionow, who performed the first face transplant in the United States and the second in the world.
In 2012, he successfully performed Turkey’s second face transplant, which was the third among full face transplants in the world and the 22nd overall. Simultaneously with this face transplant, the world’s first quadruple limb transplant was carried out at Hacettepe University by a large team under his leadership.
He won second-place awards in the experimental and clinical specialist competitions at the 31st and 32nd National Plastic, Reconstructive and Aesthetic Surgery Congresses. In 2023, he completed his doctorate in Hand Surgery at Hacettepe University Faculty of Medicine.
He is a member of the American Society of Reconstructive Microsurgery, Plastic Surgery Research Council, Turkish Society of Plastic, Reconstructive and Aesthetic Surgery, Reconstructive Microsurgery Association, and Turkish Society for Surgery of the Hand and Upper Extremity.
