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Date of last update: 8/13/2017.

Forum Name: Urology Topics

Question: reconstruction of urethra

 dirk_dickler - Thu Dec 18, 2008 2:54 pm

I have a urinary tract that is severely undersized, with a severely restricted opening as well. I've had several surgeries to enlarge the opening but they have not helped and created scar tissue, which has resulted in a spraying urine stream.

after having an x-ray by my urologist, it appeared my entire urnary tract was undersived and would need to be reconstructed. the reason i needed the surgery is because over the years i've been getting several cases of urine infections as a result of urine backing up into my kidneys and not being able to totally empty my bladder.

my surgeon has given my two options:

1. to totally rebuild my urinary tract, with the downside being they would have to harvest skin tissue from my mouth to use as the skin material to rebuild my urinary tract. the recovery would take a month and they would have to put a cathater in my cuck and it would be extremely painful, with a success rate of 88%.

2. bypass my urinary tract and cut a hole below my scrotum that would be my new exit point for urine (as well as as semen) the drawbacks of this operation would be obvious: i need to squat to urinate. the upside, i can still get an erection and ejaculate, and the recovery time is quicker with a better 98% success rate.

my question for you guys is: has anyone had this procedure? (#2) what kind of muscle control can you excersize in squeezing off the flow? can i expect leakage more easily than through my penis, for either fluid? does the sensation of having to urinate operate differently if i get #2?

and generally, your opinions on which procedure is better, overall. After all, I am dirk dickler, and the function of my penis is very important to me!

thanks guys!
 Dr.M.Aroon kamath - Tue Oct 20, 2009 8:53 am

User avatar Hi,
In a case such as yours, no amount of description could replace clincal examination (inspection and palpation). Therefore i will try to answer your question from a general point of you rather than as a specific recommendation pertaining to your case.
Stictures of urethra that are longer than 2 cms (some authors site 3-5 cms)
are not suitable for an anastamotic urethroplasty(ie: removing the stricture and joining the cut ends).
Larger lengths of strictures need some kind of urethroplasty.(in your case, the urologist has suggested a buccal mucosal graft).

Generally,if the penis is left intact(as in a perineal urethrostomy without penectomy), there should not be a problem with erection or ejaculation or orgasm(except that the ejaculate would naturally exit through the urethrostomy).The bulbo spongiosus muscle would still be acting(if it is in good shape and not involved in the stricture process or due to repeated surgeries).
On the contrary,a urethroplasty is an extensive procedure (associated with its own complications,successes and failure rates).
If it turns out to be successful, well, NOTHING LIKE IT!
But,in case it leads to recurrence, one may end up in square 1!I hope this info will be useful to you in your decision making.Good luck!

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