Urethroplasty (Surgery for Urethral Stricture)
Definitive repair of a urethral stricture. Cutting the stricture from inside brings quick relief but it comes back — and every repeat makes the next repair harder. This page explains how that cycle is broken.
Last medically reviewed: October 4, 2026 — Assoc. Prof. Dr. Müslüm Ergün
Private Online Consultation
A private, one-to-one video consultation by appointment, without visiting the clinic. Especially for patients who value privacy.
- Procedure time
- 2–4 hours depending on stricture length
- Anesthesia
- General anaesthesia
- Hospital stay
- 1–3 nights
- Stay in Türkiye
- 3–4 weeks (the catheter is removed here)
- Catheter duration
- 2–3 weeks
- Return to work
- 2–4 weeks (desk work sooner)
- Flight clearance
- After catheter removal and review
About the condition
The urethra is the channel that carries urine out of the bladder. When scar tissue develops in part of it and narrows it, the result is a urethral stricture. The symptoms begin insidiously: a weakening stream, spraying, hesitancy, a feeling of incomplete emptying, frequency and recurrent urinary infections.
THE CENTRAL DISTINCTION ON THIS PAGE: URETHROTOMY OPENS, URETHROPLASTY REPAIRS. Cutting the stricture from inside opens the narrowing, but the scar tissue that caused it stays where it is. The body heals the cut with further scar tissue, so the stricture tends to recur.
THAT IS THE REAL HARM OF REPEATED ENDOSCOPIC TREATMENT: each procedure creates fresh scar, the stricture lengthens rather than shortens, and the surrounding tissue stiffens. Repeated urethrotomy therefore not only fails to help, it makes the eventual reconstruction harder. A first urethrotomy is reasonable for a short, well-placed stricture; the problem is doing the same thing over and over.
There are two basic approaches in urethroplasty. For short strictures the narrowed segment is excised and the healthy ends joined (excision and anastomosis). For longer strictures the channel is widened with a patch of tissue (augmentation). The usual graft is mucosa taken from the inside of the cheek, chosen because it is accustomed to a moist environment and the donor site heals quickly.
A STAGED REPAIR IS NOT A FAILURE. In heavily scarred, very long strictures, or where several procedures have already been performed, the repair may be planned in two stages months apart. For an international patient this has a concrete consequence: two separate journeys. It must be discussed before any booking is made.
Who is it suitable for?
May be suitable
- Men whose stricture has recurred after urethrotomy or dilatation
- Men with long strictures, where cutting is unlikely to give a durable result
- Men with strictures in more than one segment
- Men who have been managing for years with intermittent self-catheterisation
- Men with strictures following trauma
- Men whose previous repair elsewhere has failed (redo)
- Men who have developed a stricture after hypospadias surgery
May not be suitable
- Men with active urinary infection: the infection is treated first
- Men with local skin infection or inflammation, in whom surgery is deferred
- Men who cannot accommodate the catheter period and the length of stay — the catheter time in this operation cannot be shortened
- Men needing an oral graft whose oral health is unsuitable, which is corrected first; smoking impairs graft healing
- Men whose general condition is unsuitable for prolonged general anaesthesia
Technology used
- Retrograde urethrography and voiding cystourethrography — the basic studies showing the site and length of the stricture
- Urethroscopy — direct inspection
- Uroflowmetry and post-void residual measurement
- Buccal mucosa graft harvest
- Lingual or labial mucosa where the cheek has already been used
- Skin flaps in selected locations
- Magnified vision and fine suture material for the reconstruction
Surgeon's experience
Verifiable information
- Redo (repeat surgery) rate
- A substantial proportion of cases are redo repairs following a failed procedure or iatrogenic injury elsewhere.
- Complex case definition
- Long-segment stricture, pan-urethral stricture, stricture due to lichen sclerosus and repeated failure fall within the complex category.
- Advanced technique used
- Augmentation urethroplasty with buccal mucosa graft; staged reconstruction where required.
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Remotely
Review of your file
Your urethrogram images, flow study and PREVIOUS OPERATION NOTES are reviewed. That last item is the critical document here: which technique was used, which segment was repaired and where the graft was taken from all change the plan directly. Whether buccal mucosa has already been harvested must be stated.
- Days 1–2
Arrival and further assessment
Examination, urethroscopy and repeat imaging if needed; the site and length are confirmed. The urine culture must be clear. If an oral graft is planned, oral health is assessed.
- Day of surgery
Repair
Excision and anastomosis or graft augmentation according to the stricture. The plan may be revised according to the tissue found at operation; this is discussed beforehand.
- Catheter period
2–3 weeks
The catheter stays while the repair heals. This period is not arbitrary and is not shortened to suit a flight. It is mostly spent at the hotel; you are mobile.
- Catheter removal
Check imaging
Before the catheter is removed, imaging confirms there is no leak at the repair. If there is, the catheter stays longer — which is why your return ticket should be flexible.
- Long term
Follow-up
Flow studies and symptom review, more frequently in the first year and regularly thereafter. Success in this operation is measured not on the table but by patency over years.
Method comparison
| Criterion | Urethrotomy / dilatation | Urethroplasty |
|---|---|---|
| What it does | Cuts the narrowing open | Removes it or widens with a patch |
| The scar tissue | Stays in place | Removed or bypassed |
| Length of procedure | Short | Long |
| Catheter time | A few days | 2–3 weeks |
| Tendency to recur | High, especially in long strictures | Markedly lower |
| If repeated | The stricture lengthens and repair becomes harder | A further repair can be planned if needed |
| Who it suits | Short, first-presentation stricture | Long, recurrent or complex stricture |
The real point here is timing: rather than spending years on repeated endoscopic treatment, bringing definitive repair forward in a suitable patient preserves tissue. Do not hesitate to ask: "How long is my stricture, where is it, and what is the next step if this procedure fails again?"
Risks
- RECURRENCE OF THE STRICTURE: more likely in long and complex strictures and in men with multiple previous procedures. A redo repair has a lower success rate than a first repair, and that should be said plainly
- Temporary altered sensation at the graft donor site, limited mouth opening and discomfort
- Infection, bleeding and urine leak at the repair
- Difficulty passing urine after catheter removal, requiring temporary recatheterisation
- CHANGES IN EJACULATION: depending on the site of the repair, reduced force or retention of part of the ejaculate can occur
- Effects on erection depending on the site — uncommon, but to be discussed specifically for your case
- Change in the direction of the stream or spraying
- Clot risk from a long operation and immobility; the return flight is planned with this in mind
Alternatives
- Urethrotomy or dilatation — reasonable for a short, first-presentation stricture in a suitable location; not a durable solution for a recurrent one
- Intermittent self-catheterisation — can delay recurrence but is not a cure, and should not be presented as something to continue for years
- Excision and end-to-end repair — for short strictures
- Buccal mucosa graft augmentation — for longer strictures
- Lingual or labial mucosa, or skin flaps, where buccal mucosa has already been used
- Staged reconstruction — for heavily scarred and very complex strictures
- Permanent urinary diversion — only in exceptional cases where repair is not possible
Recovery
First 48 hours
Pain is managed with medication. If an oral graft was taken, soft food is advised for the first days; speaking and chewing may be uncomfortable briefly.
Week 1
Discharge with the catheter. Walking is fine; lifting, cycling and straddling positions are not. Avoid constipation with fibre and fluids.
Weeks 2–3
The catheter period continues, mostly at the hotel. You are mobile but activity is limited. If the catheter blocks or comes out, seek help immediately.
After catheter removal
Stinging and some straining are usual at first, and the stream may take a few days to strengthen. If you cannot pass urine at all, seek help immediately.
Weeks 4–8
Graded return to normal activity. For intercourse, follow the interval your surgeon gives you; resuming early can stress the repair.
First year and beyond
Regular follow-up with flow studies. If you notice the stream weakening, do not wait: a narrowing caught early can be dealt with before it obstructs.
Frequently asked questions
I have had several urethrotomies and it keeps closing. Should I try once more?
You are right to ask. Each cut creates fresh scar; over time the stricture lengthens rather than shortens and the surrounding tissue stiffens. Repeated urethrotomy therefore not only fails to help, it makes the eventual definitive repair harder. Beyond a certain point, "let us open it once more" is not in your interest.
My previous repair elsewhere failed — can it be redone?
In most cases yes, but a second repair is a different operation and must be planned differently. Your previous operation note, the technique used and where the graft was taken from determine that plan directly. It should also be said plainly that a redo has a lower success rate than a first repair, and that the difference grows with the number of previous procedures.
My buccal mucosa has already been taken — are there other options?
Yes. If both cheeks have been used, mucosa from under the tongue or from the inner lip can be used, and in some locations skin flaps raised from nearby tissue are an option. Which applies depends on the site and length of the stricture. Please state this when you make your enquiry.
Does taking tissue from my mouth cause lasting problems?
The donor site inside the cheek usually heals quickly. In the first days there may be limited mouth opening, discomfort and altered sensation; soft food is advised. Smoking impairs healing both at the donor site and at the repair.
Why does the catheter stay so long — can it be shortened?
No. It is the time needed for the repair to heal watertight, and it is not shortened to suit a flight. Imaging checks for a leak before removal, and if there is one the catheter stays longer. For that reason we advise a changeable return ticket and a few days of margin in your stay.
Might it not be finished in one operation?
Yes. In heavily scarred and very long strictures the repair may be planned in two stages months apart: the urethra is opened and the graft laid down to mature, then closed into a tube at the second stage. This is not a sign of failure but the approach most likely to give a durable result in difficult tissue. It does mean two journeys, and it must be discussed before booking.
Will my sexual function be affected?
That depends on which part of the urethra is repaired. Reduced force of ejaculation or retention of part of the ejaculate can occur. Effects on erection are uncommon but vary by site and should be discussed specifically before surgery.
How will I know whether the operation worked?
Success here is measured not on the table but by patency over years. Follow-up is by flow study and symptom review. If you notice the stream weakening, do not wait: a narrowing caught early is far easier to address than complete obstruction.
Does every urology centre perform this operation?
Urethroplasty is not a frequent part of routine urological practice, and long-segment and redo cases in particular require specific experience. It is therefore reasonable to ask which technique is planned, how often the surgeon performs it, and what will be done if the plan changes during the operation.
What should I send before coming?
The urethrogram images themselves (not only the report), any urethroscopy record, uroflowmetry and post-void residual, ALL PREVIOUS OPERATION NOTES, how many urethrotomies or dilatations you have had and when, whether buccal mucosa has already been harvested, your medication and your other medical conditions. With these it can be assessed before you travel whether the repair would be single or staged.
Articles on this topic
Scientific sources
This page is for general information only and is not a substitute for medical advice.
Let's talk about this treatment
Message us on WhatsApp with your questions or fill in the pre-assessment form.
Pre-assessment form
Leave your details and our team will get back to you shortly.
Other treatments
Pyeloplasty (Surgery for PUJ Obstruction)
Repair of the narrowing where the kidney drains. The dangerous feature of this condition is that it can progress without pain: the kidney quietly dilates and loses function. The aim is to preserve the kidney.
Learn moreVesicovaginal and Ureterovaginal Fistula Repair
Repair of fistulas causing continuous urinary leakage. This is not a personal failing but a repairable medical condition — and the two things that matter most are correct timing and getting the first repair right.
Learn moreUreteric Reconstruction (Long-Segment Stricture and Injury)
Advanced repair to save the kidney in long ureteric strictures. Most of these patients have been told it cannot be done — yet the length of the stricture alone does not mean repair is impossible.
Learn more