Urethroplasty is surgery to repair or reconstruct the urethra, the tube that carries urine from the bladder out of the body. It’s most commonly performed when scar tissue narrows the urethra (a condition called a urethral stricture), blocking or slowing the flow of urine. With long-term success rates above 95% at five years for select cases, it’s considered the gold standard treatment for urethral strictures that haven’t responded to simpler procedures.
Why Urethroplasty Is Recommended
The urethra can narrow when scar tissue builds up inside it. This scarring might result from injury, infection, prior surgeries or catheterizations, or a skin condition called lichen sclerosus. Some people are born with urethral differences (hypospadias or epispadias) that are repaired in childhood but can develop blockages later in life. Whatever the cause, the result is the same: urine has trouble getting through, leading to a weak stream, straining, incomplete emptying, or recurrent urinary tract infections.
Less invasive options exist. A doctor can stretch the narrowed area (dilation) or cut through the scar tissue with a small scope (internal urethrotomy). These work well for a first-time, short stricture, but they carry a high chance of the scar tissue returning. The American Urological Association recommends urethroplasty instead of repeated stretching or cutting for strictures that come back, strictures in the penile urethra, and bulbar strictures 2 cm or longer, where those simpler approaches have low success rates.
How Surgeons Diagnose and Plan the Procedure
Before surgery, your urologist needs a precise map of the stricture: where it is, how long it is, and how severe the narrowing has become. This typically starts with a flexible camera exam (cystoscopy) when you first report symptoms. A more complete picture comes from a retrograde urethrogram, an X-ray taken while contrast dye is gently injected into the urethra. In some cases, a voiding study is added, where you urinate while images are captured, to evaluate areas closer to the bladder. Ultrasound and MRI are occasionally used as well.
A urine culture is taken one to two weeks before surgery to check for infection. If bacteria are found, you’ll take a course of antibiotics beforehand so the surgical site is as clean as possible.
Types of Urethroplasty
The specific technique depends on the length, location, and cause of the stricture. The two main categories are direct reconnection and graft-based repair.
Excision and Reconnection
For shorter strictures, the surgeon can cut out the scarred section entirely and stitch the healthy ends of the urethra back together. This is called anastomotic urethroplasty. It works well because you end up with a urethra made entirely of your own original tissue, with no patch material involved.
Graft Substitution
When the stricture is too long to simply remove and reconnect (or when the location makes that approach risky), the surgeon uses a patch of tissue to widen or replace the narrowed segment. The preferred graft material is tissue harvested from the inside of your cheek, called buccal mucosa. It became the go-to option because it’s naturally hairless, thrives in a wet environment, has a reliable blood supply that helps it heal quickly, and is easy for surgeons to work with. The American Urological Association and European guidelines both recommend oral mucosa as the first-choice graft. Tissue from the inner lip (lingual mucosa) is considered an equivalent alternative.
Both approaches produce similar long-term results for short strictures. One study comparing the two in the bulbar urethra found equivalent success rates, with the graft technique producing somewhat fewer complications, leading the authors to suggest it as the preferred choice even for shorter strictures in that location.
Robotic-Assisted Surgery
For strictures located deeper in the body, near the prostate or bladder neck, some centers now offer robotic-assisted urethroplasty. In a review of 105 patients at a single center, surgical success rates matched those of traditional open surgery, with improved continence outcomes. About 39% of those patients required a combined approach through both the abdomen and perineum. This technique is particularly relevant for men who have had pelvic radiation or pelvic fracture injuries, which accounted for over half the patients in that series.
What Recovery Looks Like
Most urethroplasty procedures take two to four hours under general anesthesia, performed through an incision between the scrotum and anus (the perineum). Depending on the complexity, you may go home the same day or stay in the hospital for one to two days.
You’ll leave with a catheter in place to keep the urethra open while it heals. This stays in for 10 to 20 days. During that time, you should limit your activity, avoiding heavy lifting, extended walking, and running. Most people can return to desk work once they feel comfortable, but physical jobs typically require waiting until after the catheter is removed and symptoms settle.
If a cheek graft was used, the donor site in your mouth heals relatively quickly. Some soreness and swelling are normal for the first week, but the inner cheek regenerates well, and long-term problems at the harvest site are uncommon.
Long-Term Success Rates
Urethroplasty is the most durable treatment available for urethral strictures, but “durable” doesn’t always mean permanent. A large meta-analysis of augmentation urethroplasty (the graft-based type) found that in carefully selected study groups, 97% of repairs were still working at one year and 96% at five years. By 10 years, that number dropped to about 74%, and by 15 years, to 63%. When all available studies were pooled together (including less uniform patient populations), the five-year success rate was closer to 77% and the 10-year rate about 59%.
These numbers mean follow-up matters. Even a successful repair can gradually re-narrow years later, so periodic check-ins with your urologist are important for catching any early signs of recurrence.
Risks and Side Effects
The most relevant concern for many patients is the effect on sexual function. Because the surgery involves tissue near the nerves and blood vessels responsible for erections, some degree of erectile difficulty is common in the weeks after surgery. In one prospective study, patients with anterior strictures saw a noticeable drop in erectile function scores at three months, but scores recovered steadily. By 12 months, function was close to pre-surgical levels, with most remaining cases rated as mild. The pattern suggests that psychological factors and temporary nerve irritation play a significant role, rather than permanent damage.
Patients who undergo repair after a pelvic fracture injury tend to experience a larger initial dip and a slower recovery, though their one-year outcomes are similar to those of patients with standard anterior strictures.
Other possible complications include urinary tract infection, bleeding, and wound healing issues at the incision site. For robotic posterior repairs, about 7% of patients in one large series experienced a significant complication within 30 days, and roughly a quarter needed at least one additional procedure during the follow-up period. Incontinence requiring further treatment occurred in about 29% of that group, though that cohort included many patients with prior pelvic radiation, which significantly increases complexity.
Urethroplasty vs. Repeated Endoscopic Treatment
If you’ve been offered urethroplasty, you may be weighing it against another round of dilation or internal cutting, which are quicker outpatient procedures with faster recovery. The trade-off is straightforward: those simpler procedures have a high recurrence rate, especially after the first attempt fails. Each repeat procedure adds more scar tissue, which can make an eventual urethroplasty more difficult. Guidelines now recommend moving to urethroplasty after a single failed endoscopic treatment rather than cycling through multiple attempts, because the long-term outcomes are significantly better with surgical reconstruction.