Product Summary: AMA rates

Removal of urethra. Usually in adjunct to a radical cystectomy. Occassionally done some time after a cystectomy where recurrences occur in urethra.

Item Number: 37330, 105

Why is it done?

  • As part of the treatment for aggressive localized Urothelial carcinoma of the bladder.
  • T1G3 ?, > T2 disease.
  • Primary Urethral disease with:
  • Urothelial Carcinoma.
  • Squamous cell carcinoma.
  • Secondary metastatic disease to Urethra: Melanoma, Lung cancer, Breast cancer (all these are rare).
  • Advanced disease may involve a penectomy.
  • The procedure is part of the radical cystectomy, radical Cysto-prostatectomy or could be and adjunct later on when recurrences are found with surveillance.
  • Part of a necrotic inflammatory condition ie: Fourniers Gangrene.

How is it done?

  • This procedure is done under general anaesthetic.
  • Legs are placed in a lithotomy position.
  • A single incision is made on the midline raphe on the perineum (area between scrotum and anus). Sutures will be dissolvable.
  • The Corpora Spongiosum with the urethra inside it is mobilized off the Corpora Cavernosa.
  • Urethal Meatus is removed distal and glans is closed.
  • Proximally the uretha is taken up to the sphincter and freed.
  • You will have already had a diversion of the urine with an ileostomy or this will be done with your cystectomy part of the operation.
  • A drain will be left for 24-48 hours to prevent the collection of serous fluids.
  • A dressing is then applied, which should be removed after 72 hours.

What to expect after the procedure?

  • Any anaesthetic has its risks and the anaesthetist will explain all such risks.
  • If this is the only operation you have undergone, you will be sent home as soon as the drain is removed on D2 or D3.
  • Swelling is a common complication.
  • A haematoma (blood collection under the skin) may form and needs to be reviewed by Dr Schoeman as soon as possible. Bruising is normal.
  • An infection of the wound may occur and requires immediate attention.
  • Owing to the area of the surgery the wound should be kept clean and dry.
  • DANGER SIGNS: A wound that swells immediately , fever, or puss. Please contact Dr Schoeman or the hospital immediately as this may occur in up to 15 % of all cases.

What next?

  • The dressing should be kept dry for the initial 72 hours after surgery and then soaked in a bath until it comes off easily.
  • The dressing may sometimes adhere to the wound causing slight bleeding on removal. Don’t panic, the bleeding will stop.
  • On discharge a prescription may be issued for patients to collect.
  • There will be signs of bruising for at least 10 days.
  • The suture-line will be hard and indurated for at least 8-10 weeks.
  • Please direct all further queries to Dr Schoeman’s Rooms.
  • You should have a review appointment to discuss the pathology found and the need for further treatment (Chemo/Radiation Therapy).

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