Flap Urethroplasty

• Doctor consultation charges
• Lab tests and diagnostic charges
• Room charges inside hospital during the procedure
• Surgeon Fee
• Cost of implant
• Nursing charges
• Hospital surgery suite charges
• Anesthesia charges
• Routine medicines and routine consumables (bandages, dressings etc.)
• Food and Beverages inside hospital stay for patient and one attendant.

• Extra Radiology Investigations
• Healthcare Professionals Charges of other consultations.
• Other Requested Services such as Laundry etc.
• Additional Pharmaceutical Products and Medicines After Discharge from Hospital.
• Management of Conditions Unrelated to Procedures or Pre-Existing.
• The cost of any additional implants will be in addition to the package cost.

Flap Urethroplasty:

When a kid is born with additional flaps of tissue growing in his urethra, the tube through which pee exits the urinary tract, urethral valves develop. The urethra cannot effectively transport urine from the bladder to the tip of the penis and out of the body because of the excess tissue.

When scar tissue grows inside the urethra, urethroplasty is used to repair or replace it. After cutting out the scar tissue, your surgeon may join the two ends of your urethra or borrow tissue from elsewhere in your body to repair the blocked piece of your urethra.

Disease Overview:

Urethral stricture disease

The major function of the urethra in both males and females is to transfer urine outside the body. For males, this narrow tube plays a vital role in ejaculation. A urethral stricture occurs when a scar from swelling, injury, or infection restricts or hinders the passage of urine in this canal. A urethral stricture can cause discomfort in certain persons.

The bladder empties into the urethra, which then exits the body (called voiding). The urethra of a woman is substantially shorter than that of a man. Urine must travel a greater distance from the bladder to the penis in men.

The posterior urethra is the first 1" to 2" of the urethra through which urine travels in males. The following organs are found in the posterior urethra:

• bladder neck (the aperture of the bladder)
• the urethra of the prostate (the part of the urethra by the prostate)
• The external urinary sphincter is a muscle that surrounds the membranous urethra.

Posterior strictures are those that occur in the first 1" to 2" of the urethra, when urine travels through.

The anterior urethra is the last 9" to 10" of the urethra in men. The following organs are found in the anterior urethra:

• the urethra bulbosa (under the scrotum and perineum- the area between the scrotum and anus)
• the urethra of the penile (along the bottom of the penis)
• the mutton (the exit at the tip of the penis)

Anterior strictures are those that occur in the final 9" to 10" of the urethra, when urine goes through.

Disease Signs and Symptoms:

To put it another way, the urethra is similar to a garden hose. The flow is lowered when there is a kink or narrowing along the hose, no matter how short or long it is. Symptoms appear when a stricture narrows to the point that urine flow is reduced. Urinary problems, urinary tract infections, and enlargement or infections of the prostate are all possible. Kidney injury might result from a severe obstruction that lasts for a long period.

The following are some warning signs:

• urine that is crimson or dark
• blood in the sperm pee stream slowing or stopping urine stream spraying discomfort during urinating abdominal pain
• leakage from the urethra
• Men's UTIs
• bladder control loss due to enlargement of the penis

Disease Causes

Because of their larger urethra, men are more susceptible to develop urethral illness or damage. As a result, men are more likely to have strictures. In women and newborns, they are uncommon.

Stricture (narrowing of the urethra) can occur anywhere throughout the urethra, from the bladder to the penis. The flow of urine into the urethra is restricted or slowed by this constriction. The following are some frequent causes:

• An infection, such as a sexually transmitted illness, or injury from surgical equipment can induce edoema in the urethra.
• In the vast majority of instances, no cause can be identified.

The most common causes of urethral strictures in adults are:

• prostate surgery after a fall onto the scrotum or perineum
• Urinary catheterization and other surgical techniques are used to remove kidney stones.

Stricture of the Posterior Urethra

The first 1" to 2" of the urethra is where posterior urethral strictures occur. This type of stricture develops as a result of an injury caused by a pelvic fracture (e.g., motor vehicle or industrial accident). The urethra is interrupted or fully sliced and split in certain circumstances. Urine is unable to pass. A catheter must be inserted into the bladder either via the belly (suprapubic tube) or through the penis. This allows urine to flow freely until the stricture is repaired.

Stricture of the Anterior Urethra

The final 9" to 10" of the urethra is where anterior urethral strictures occur. This type of constriction is brought on by:

• a straddle injury's trauma (from falls onto objects where the legs are on either side)
• Penis trauma is a type of direct trauma to the penis.
• Catheterization

Disease Diagnosis:

There are various tests that may be used to see if you have a urethral stricture, including the following:

• physical examination
  
• imaging of the urethra (X-rays or ultrasound)
• urethroscopy is a procedure that examines the urethr (to see the inside of the urethra)
• urethrogram taken backwards
• Urethroscopy

A tiny, flexible, lubricated scope (a little viewing tool) is gently placed into the urethra by the doctor. It has been elevated to the stricture. The doctor will be able to view the narrowed region as a result of this. This is done in the office and aids your doctor in determining the best course of treatment for your stricture.

Urethrogram in reverse

This test is used to determine the number of strictures present, as well as their location, duration, and severity. This is an X-ray operation that may be done as an outpatient. In this example, retrograde indicates "against the flow" of urine. At the tip of the penis, a contrast dye (fluid that can be seen on an X-ray) is introduced into the urethra. There are no needles or catheters utilised. The dye indicates the restricted region and allows the doctor to see the whole urethra. It may be used in conjunction with an antegrade urethrogram (antegrade means "with the flow" of urine). Dye is injected into the urethra from below, filling it up to the damaged region. Dye is injected from above, filling the bladder and urethra all the way to the stricture.

The doctor can use the results of these tests to determine the gap and arrange for surgery.

You may also undergo this X-ray technique following emergency treatment if you suffer urethral injuries. Contrast dye can be administered through the catheter used to repair the wound.

Disease Treatment:

Depending on the magnitude of the obstruction and the amount of scar tissue involved, there are a variety of alternatives.

The following are some of the treatments:

dilation — gradually extending the stricture to enlarge it

open surgery - surgical excision of the stricture with reconnection and repair, potentially with grafts urethrotomy – removing the stricture with a laser or knife through a scope (urethroplasty)

There are no medications available to aid with the treatment of strictures.

You will continue to experience voiding issues if you do not seek therapy. Infections and stones in the urinary and/or testicles are possible. Urinary retention (inability to pass urine) is also a possibility, which can lead to an enlarged bladder and kidney issues.

Dilation

This is commonly done under local anaesthetic in the urologist's office. The stricture is stretched by utilising "sounds," which are progressively bigger dilators. A catheter with a specific balloon can potentially stretch the tissue. However, stretching is not a cure and must be done on a regular basis. If the stricture recurs too frequently, you may be taught how to use a catheter to prevent it from recurring. Bleeding and infection are two possible side effects. Stretching can result in the formation of a "false passage" or second urethral channel.

Urethrotomy

This procedure involves moving a special scope through the urethra until the stricture is discovered.

The stricture is sliced and a space is created using a knife blade or laser at the end of the cystoscope. To keep the gap open and allow it to heal, a catheter can be inserted into the urethra. The length of the stricture determines how long a catheter tube should be left draining.

Surgical Procedures in the Open

Strictures have been treated using a variety of reconstructive treatments, some of which need just one or two operations. The kind of correction is determined by the location and duration of the stricture, as well as its severity. There is no one-size-fits-all solution for every situation. Anastomotic urethroplasty and replacement urethroplasty are the two most common forms.

Anastomotic Urethroplasty is a kind of urethroplasty in which the urethr

Short urethral strictures are commonly treated with this approach. A cut is made between the scrotum and the rectum in this circumstance. After the stricture has been removed, the urethra can be rejoined. This is normally done as an outpatient procedure or with a brief stay in the hospital. For 10 to 21 days, a tiny, soft catheter is left in the penis. After an X-ray to ensure that the repair has healed, it is removed.

Urethroplasty with Substitution

Tissue can be transplanted to replace the part with the stricture if the stricture is lengthy. Substitution repairs may need to be done in phases in tough circumstances. These procedures should be performed by a urologist who is familiar with these procedures. Overall, the success rate is rather high.

The following are the three types of replacement procedures:

• Staged 
  
• free graft 
• skin flap
• Graft for free

This procedure uses your own tissue to replace or expand a piece of the urethra. Skin (from the shaft of the penis) or buccal mucosa are the most common tissues used (taken from inside the cheek). You may need to stay in the hospital for a few days after surgery and wear a catheter for two or three weeks.

Flap in the Skin

Skin flaps from the penis are turned to produce a new portion of the urethra in this procedure. When a transplant must be lengthy and the stricture is severe, this is required. These treatments are complicated and should only be performed by a plastic surgeon with prior training.

You may need to stay in the hospital for a few days after surgery and wear a catheter for two or three weeks.

Staged

When local tissue won't work for a free graft or a skin flap, this procedure is employed.

The underside of the urethra is opened in the first step, revealing the complete length of the stricture. The opening urethra is secured with a graft. For 3 to 12 months, the graft cures and grows. You will urinate via a new hole behind the stricture at this period. While the graft is healing, you may need to sit down to pee.

Second stage – Several months after the graft around the urethra has healed, and it is soft and flexible, the graft is formed into a tube. The urethra then returns to normal. A small, soft catheter is left in the penis for 10 to 21 days