Urethral stricture surgery, or urethroplasty, aims to permanently resolve urinary tract obstruction caused by urethral scarring. The procedure involves reconstructing the passage that carries urine from the bladder out of the body. Operating within the realm of reconstructive urology, clinicians utilize precision microsurgical techniques to remove narrowed segments or widen them using autologous mucosal grafts, predominantly harvested from the oral cavity.

Urethroplasty is performed under general anesthesia. The patient is placed in the lithotomy position. The surgeon makes an incision along the perineum or penis to access the urethra. After identifying the stricture site, the surgeon chooses between an excision with primary anastomosis or a substitution technique. For primary anastomosis, the scarred segment is excised and the two healthy ends are sutured together without tension. For substitution urethroplasty, the narrowed segment is opened longitudinally, and a graft—typically harvested from the inner cheek mucosa—is sewn into place to widen the passage. A temporary urinary catheter is placed across the repair, and the incision is closed in layers.

Clinical research demonstrates that urethroplasty provides long-term success rates between 85% and 95%, significantly outperforming endoscopic treatments for durable stricture resolution (AUA Guidelines 2016, EAU Guidelines 2021). The procedure permanently restores peak urinary flow rates, alleviates painful voiding, resolves post-void dribbling, and reduces the risk of long-term bladder damage or chronic urinary tract infections. By eliminating the cycle of repetitive endoscopic dilations, urethroplasty improves quality of life and preserves renal function.

Initial recovery involves light activity at home for two to three weeks while a Foley catheter drains urine to allow the reconstructive site to heal without contact with urine. Most patients experience mild perineal discomfort managed with standard analgesics. Normal daily routines and sedentary work resume after catheter removal, which takes place between 14 and 21 days following a successful cystogram. Heavy lifting, strenuous exercise, bicycle riding, and sexual activity are restricted for six weeks post-surgery to prevent graft disruption or wound dehiscence.

Urethroplasty treats luminal narrowing of the male and female urethra caused by idiopathic fibrosis, direct perineal trauma, iatrogenic instrumentation, failed hypospadias repairs, lichen sclerosus, or pelvic fracture urethral injuries. It addresses severe lower urinary tract symptoms, urinary retention, recurrent urinary tract infections, bladder dysfunction, and secondary kidney injury caused by chronic outlet obstruction.

Preoperative preparation includes a full uroflowmetry study, retrograde urethrography, and urine culture to ensure the urinary tract is sterile. Patients must stop blood-thinning medications several days before surgery as advised by their physician. Bowel preparation or skin antisepsis routines may be instructed. Oral health evaluation is required if a buccal mucosa graft is planned. Patients fast from midnight prior to the operation.

Complications are stratified by severity. Common, mild risks include local bruising, mild pain, lower urinary tract irritation, and minor bleeding from the catheter. Less common risks include wound infection, temporary loss of skin sensation in the scrotum or perineum, and graft failure. Rare but serious risks involve persistent erectile dysfunction, ejaculatory dysfunction, urinary incontinence, deep vein thrombosis, or stricture recurrence requiring re-intervention.

The clinical path for urethroplasty begins with a comprehensive diagnostic evaluation, including retrograde urethrography (RUG) and flowmetry to map stricture location and length. On the day of surgery, general anesthesia is administered, and reconstructive microsurgery is performed over one to three hours. Patients typically spend one night in the hospital for observation. A urinary catheter remains in place for two to three weeks to allow full mucosal healing. A follow-up voiding trial and imaging confirm urethral patency prior to catheter removal, followed by structured uroflowmetry assessments at regular intervals over the subsequent year.