Urethroplasty Post-Op Recovery Instructions

About Urethroplasty Recovery

Urethroplasty is open surgical reconstruction of the urethra — the gold-standard treatment for recurrent urethral stricture disease with success rates of 85-95% for most repair types. Recovery centers on three things: protecting the surgical repair while it heals, keeping the urinary catheter functioning, and confirming the repair is watertight before the catheter is removed.

What sets urethroplasty recovery apart:

• Catheter duration is shorter than many patients expect. Most urethroplasty patients keep the urethral catheter in for ~3 weeks (occasionally 1-4 weeks depending on the repair). This is much shorter than fistula repair or some other reconstructive procedures.
• Contrast study (VCUG). Most patients will remove their own catheter at home without needing a contrast study. Some patients may require a voiding cystourethrogram (VCUG) — a low-radiation x-ray with contrast — to confirm there is no leak at the repair site. If a leak is present, the catheter stays in another 1-2 weeks and the study is repeated.
• Perineal incision care matters most early. If your repair was performed through the perineum (between the scrotum and anus), the most important rule for the first 4-6 weeks is no straddling and no pressure on the incision. Sit with weight shifted to your buttocks or use an air-filled donut cushion.
• Buccal mucosa graft donor site. Many longer strictures are repaired with a graft of tissue from the inside of the cheek. The mouth heals faster than the urethra — most discomfort resolves within 7-10 days — but the mouth incision needs gentle care during that window.
• Stricture recurrence is monitored long-term. Even with excellent technical results, a small percentage of strictures recur. Dr. Vanni's follow-up protocol is designed to catch any early narrowing while it can still be managed conservatively.

Urethroplasty Post-Operative Instructions

What you can expect

• Bruising and some mild bleeding from incision site(s).
• Mild bruising and swelling of scrotum.
• Mild pain in perineum, scrotum, and hips that should improve with activity during the first week after surgery.
• Leakage of urine or bloody fluid from the end of the penis or around the catheter.
• Bladder spasms: can feel like pressure or pain and result in leakage of urine around catheter.
• Nocturnal erections: totally normal and impossible to prevent even with a catheter in place. You can place aquafor or vaseline at the top of the meatus before bed for comfort.

If you had a buccal mucosal graft harvested from your mouth

• Mild swelling and discomfort of cheek that should improve gradually each day.

Dressing Care

• If you have a wrap around your penis, please remove this on the first day after your operation unless told differently by your doctor.

Activity

• No heavy lifting (more than 20 lbs) while catheter in place.
• No driving if taking narcotic pain medication.
• Use stairs infrequently, and take only one step at a time.
• No vigorous activity while catheter in place (shoveling snow, mowing the lawn, raking leaves etc).
• No sexual activity while catheter in place or 3 weeks at earliest.
• If you experience discomfort, reduce activity, and more gradually resume activities.
• Regular light activity and walking is encouraged several times daily. Limit the amount of walking with the catheter in place to no more than several light 15 minute walks per day. Do not be a couch potato.
• Once your catheter has been removed (~3 weeks), you may resume regular physical activity.

For men with a perineal incision

• If you have a perineal incision (between the scrotum and anus), you should sit with your weight shifted onto you buttocks for comfort as needed. You may use an air-filled donut or soft cushion for 4 weeks.
• No activity that involves straddling for 6 months (riding a bike, motorcycle, ATV, horseback riding etc).

Diet

• Drink plenty of fluids (6-8 glasses of water daily).
• Resume regular diet at home.
• If you have a special diet due to diabetes, kidney disease, liver disease etc, you may resume eating when tolerated.

If you had a buccal mucosa graft harvested from your mouth

• Magic Mouthwash as needed for mouth discomfort
• Swish and spit 1-2 ounces (30-60 ml) of mouthwash or half strength hydrogen peroxide and saline solution four times per day until your mouth incision is completely healed.
• You may resume brushing your teeth the day after surgery.
• You may return to your normal diet after surgery as tolerated.
• Begin slowly stretching the mouth once comfortable to help reduce tightness

Medications

• Pain control with 600 mg ibuprofen and 500 mg Tylenol every 6 hours unless your doctor states otherwise. These medications can be staggered so that you can take something every 3 hours.
• Resume all medications you normally took before surgery, unless instructed otherwise.
• Resume Aspirin and blood thinners as directed by your physician.
• If you have any questions regarding your medications, please call our office at 781-744-8420 or call the Lahey Clinic Urologist on-call.

Bowel habits

• Avoid constipation to prevent straining (do not strain when having a bowel movement).
• Increase fiber in your diet
  • Fruits, vegetables, salads
  • Metamucil
• Drink plenty of fluids (8 glasses of water a day)
  • Can add prune or apple juice
• Stool softeners
  • Colace
• Laxatives

  Catheter Care

• You will have a urethral catheter after surgery. You may also have a suprapubic tube (SP tube) that is placed in your bladder and comes out of the lower abdominal wall.
• The urethral catheter will remain in place for 1-4 weeks after surgery.
• If you have a suprapubic tube, the SP tube will generally be removed after the urethral catheter.
• Your catheter(s) should be anchored at all times to either your thigh or calf or abdomen. You will be instructed on how to do this while in the hospital.
• Using soap and water, wash around the meatus at the point of entry of the catheter. Place a small amount of bacitracin (triple antibiotic ointment) around the meatus three times a day until the catheter is removed.
• If your catheter becomes obstructed or falls out contact the office at 781-744-8420 or call the Lahey Clinic Urologist on-call.

Bathing

• Shower daily beginning 48 hours after surgery.
• Gently wash the incision with soap and water, rinse, and pat dry.
• No baths, hot tubs, or swimming for 6 weeks or until after the catheter(s) have been removed

If you have a 1st stage buccal mucosal graft care (you are having a planned 2nd surgery 6 months later)

• Shower every day after the bolster is removed.
• Gently soap up the lower abdominal area and allow the soap and water to wash over the graft.
• Do not scrub the graft with soap and water.
• Gently pat the graft dry and allow to air dry.
• Once the bolster is removed: put thin coat of aquafor over entire graft area 4 times per day until the 2nd surgery (~6 months later).

Common Concerns

• Leakage of urine or bloody fluid from the end of the penis or around the catheter.
  • You may experience pain or pressure in the bladder when this leakage occurs.
  • Check to determine if the catheter is draining properly.
    • If the catheter is draining, these symptoms are not dangerous.
• If you have continuous painful bladder spasms that do not go away or if you have other questions or concerns, call the Lahey Clinic Department of Urology at 781-744-8420.

Reasons to call your doctor

• Incision becomes red, swollen, opens, or has pus-like drainage.
• Skin around your incision becomes warmer than elsewhere.
• Decreased or absent urine from your catheter for 2 hours.
• Catheter becomes dislodged.
• Chills or fever greater than 101 degrees F.
• Nausea and vomiting or inability to keep down fluids.
• Severe pain not controlled by pain medication.

Additional instructions

• Given on a case by case basis. Ask your surgeon if any other instructions are necessary.

For emergent situations call 911 or go to the Emergency Room.

Please feel free to contact us with any other questions or concerns at 781-744-8420.

Urethroplasty-Specific Warning Signs

In addition to the general warning signs above, these symptoms warrant prompt contact with Dr. Vanni's office because they can indicate a problem at the repair site:

• Sudden, painful inability to urinate after the catheter has been removed — this is the classic sign of stricture recurrence and should be evaluated within 24 hours.
• Progressively weaker urinary stream over weeks or months — even subtle weakening can be the first sign of restricture.
• Spraying or splitting of the urinary stream after recovery — may indicate narrowing at the meatus or anastomotic site.
• Increasing time required to empty the bladder or a sense of incomplete emptying.
• Significant new urinary tract infections after a long symptom-free period.
• Bloody drainage from the perineal incision that doesn't resolve within a few days.
• For buccal graft patients: any non-healing, bleeding, or significant numbness at the cheek donor site.

Follow-Up Schedule & Stricture Surveillance

• ~3 weeks (catheter removal): Most patients remove their own catheter at home. Some patients may require a voiding cystourethrogram (VCUG) in the office before catheter removal to confirm a watertight repair.
• 3 months: Office uroflowmetry (Qmax) and post-void residual (PVR) ultrasound to objectively measure stream strength and bladder emptying.
• 6 months: Repeat uroflow and PVR. Cystoscopy in selected cases.
• 12 months: Cystoscopy in the office to directly visualize the repair. This is the most reliable way to confirm long-term patency.
• Annually thereafter: Symptom check and uroflow. Cystoscopy if symptoms develop. Most recurrences appear within the first 2 years, but late recurrences are possible.

This schedule may be modified based on the type of urethroplasty performed (anastomotic, buccal graft onlay, two-stage repair, etc.) and any prior interventions. Dr. Vanni will provide a written follow-up plan at your first postoperative visit.