Urethroplasty
Urethroplasty is an operation to repair a narrowed, scarred section of the urethra, the tube that carries urine out. The surgeon either cuts out a short scar and rejoins the healthy ends, or widens a longer scar with a graft taken from the inside of your cheek.
Also called urethral reconstruction, urethral stricture surgery, stricture repair, buccal mucosa graft urethroplasty, BMG urethroplasty, excision and primary anastomosis, EPA, anastomotic urethroplasty
- Where
- Hospital operating room
- Anesthesia
- General anesthesia
- Time in the room
- About 2 to 4 hours
- Hospital stay
- Same day or one night
- Going home with
- A urethral catheter for about 2 to 3 weeks
- Back to normal
- About 2 to 3 weeks for light activity; about 6 weeks for full activity
- Back to work
- About 1 to 2 weeks for desk work, with the catheter in; 4 to 6 weeks for heavy work
Overview
A urethral stricture is a section of scar tissue that narrows the urethra. Urine has to squeeze through, so the stream becomes weak, slow or split, and it can take a long time to empty. Some men get repeated infections or suddenly cannot pass urine at all. Strictures can follow an injury, a catheter or scope, an infection, or a skin condition called lichen sclerosus, but often no cause is found.
Stretching the scar (dilation) or cutting it from the inside (urethrotomy) can help for a while, especially for a first, short stricture. When a stricture comes back, those treatments work less well each time. Urethroplasty rebuilds the urethra through an incision and gives the best chance of a lasting cure.
The operation is planned around the length and location of the scar. For a short scar in the bulbar urethra (the part behind the scrotum), the surgeon can often cut out the scarred piece and sew the healthy ends back together. This is called excision and primary anastomosis. For a longer scar, the surgeon opens the narrow section lengthwise and sews in a patch of lining taken from the inside of your cheek, called a buccal mucosa graft. Cheek lining is used because it is tough, comfortable being wet, and heals well in its new home.
Urethroplasty is a specialized operation, and results are best with a surgeon who does it regularly. For strictures in the bulbar urethra, success rates of about 8 to 9 in 10 or better are typical.
The parts of your body involved
The urethra runs from the bladder through the prostate and past the sphincter muscle, then through the bulbar urethra behind the scrotum and along the penis to the tip. The part from the sphincter to the tip is called the anterior urethra, and this is where most strictures form. It is wrapped in a spongy layer of tissue (the corpus spongiosum) with a rich blood supply, which helps grafts and repairs heal.
- Bladder
Stores urine. Years of pushing against a stricture can thicken its wall.
- Prostate and sphincter
Above the stricture. Repairs of the anterior urethra stay below the sphincter, so new leakage afterward is uncommon.
- Bulbar urethra
The section behind the scrotum. It is the most common place for strictures, and repairs here have the best results.
- Penile urethra
The section inside the penis. Strictures here are often longer, may be linked to lichen sclerosus or earlier hypospadias surgery, and sometimes need a repair done in two stages.
- Inner cheek
The moist lining inside the cheek (buccal mucosa). A strip of it is used as a patch when the scar is too long to cut out.
Why it’s done
Urethroplasty is usually recommended when a stricture keeps coming back, or when it is too long or complex for stretching or cutting to last.
- A stricture that came back
AUA guidelines recommend offering urethroplasty, rather than repeated cutting or stretching, when a stricture returns.
- A long stricture
Scars longer than about 2 cm (under an inch), or in more than one place, rarely stay open after cutting or stretching.
- Penile strictures and lichen sclerosus
These rarely respond for long to cutting or stretching and usually need a graft repair.
- Injury to the urethra
Strictures after a straddle injury, or a torn urethra after a pelvic fracture, are repaired with forms of this surgery.
- Problems caused by the blockage
Being unable to pee, repeated urinary infections, bladder stones, or a bladder that no longer empties well.
- Ending repeated procedures
Many men are tired of self-dilating or repeated trips to the operating room and want a lasting fix.
Other options
- Urethrotomy or dilation
Opening the scar from inside with a tiny knife or a balloon. Reasonable for a first, short bulbar stricture; less likely to last each time it is repeated.
- Drug-coated balloon (Optilume)
A balloon coated with a medicine that slows scar regrowth, for shorter strictures that have come back. Better results than plain stretching in a trial, with less long-term data than urethroplasty.
- Self-dilation
Passing a soft catheter yourself on a regular schedule to keep the scar from closing. It can keep the urethra open, but only for as long as you keep doing it.
- Suprapubic catheter
A tube through the lower belly into the bladder bypasses the urethra completely. An option for men who cannot have, or prefer not to have, reconstruction.
- Perineal urethrostomy
A new opening for urine is made between the scrotum and anus, so you sit to pee. Used for very long or complex strictures, or after a repair that did not work.
- Watching
If your stream is only mildly slow, you empty well, and you have no infections, regular check-ups are reasonable.
Getting ready
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Weeks to months before
The week before
The day before and the morning of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep
You have general anesthesia and receive antibiotics through an IV. If a cheek graft is planned, the breathing tube is often placed through the nose so the mouth is free.
After the operation
Right afterward
- Waking up
You wake up with a catheter, soreness between the legs, and, if a graft was taken, a sore, swollen cheek.
- Mouth care
Ice chips and cold drinks help the cheek. You can usually start soft foods the same day.
- Leg checks
Nurses check the feeling and movement in your legs, because of the time spent in stirrups.
- Pain and spasm medicine
Acetaminophen and an anti-inflammatory if safe for you, a few stronger tablets, and often a medicine for bladder spasms.
- Catheter teaching
A nurse shows you how to switch between the leg bag and the night bag and how to keep the catheter secured.
- Going home
Many men go home the same day or the next morning, with the catheter in place.
At home
- Catheter care
Keep the catheter taped or strapped to your thigh so it does not tug. Clean where it enters the penis with soap and water daily. Do not let anyone except your urology team remove or replace it.
- Bladder spasms
Sudden cramps with urine leaking around the catheter are common. Spasm medicine helps, and they ease once the catheter is out.
- Your mouth
Eat soft, cool foods for several days and avoid spicy, salty or crunchy foods. Rinse with salt water or the prescribed rinse after meals. Most men eat normally within 1 to 2 weeks.
- Wound and swelling
Bruising and swelling of the scrotum and perineum are common. Ice for 20 minutes at a time in the first 2 days and snug briefs help. Shower after 24 to 48 hours; avoid baths until your surgeon says the incision has healed.
- Sitting
Sitting on the incision is sore at first. A soft cushion or sitting slightly to one side helps. Avoid bicycles and other straddle seats for about 6 weeks or as your surgeon advises.
- Activity and lifting
Walk every day. Avoid lifting more than about 10 to 15 pounds, straining and hard exercise for about 6 weeks.
- Bowels
Pain medicine can cause constipation. Drink plenty of fluids and use a stool softener so you do not strain.
- Driving
Do not drive while taking opioid pain medicine. Many men drive within 1 to 2 weeks once sitting is comfortable.
- Sex
No sexual activity until the catheter is out and your surgeon clears you, usually about 4 to 6 weeks. Night-time erections with the catheter in can be uncomfortable; this is expected.
- Work
Desk work is often possible within 1 to 2 weeks, even with the catheter. Heavy work usually waits 4 to 6 weeks.
Recovery timeline
- Day 0Surgery
The repair is done, and many men go home the same day or the next morning.
- Days 1 to 5Home with a catheter
The cheek is most sore on days 2 to 4. Perineal soreness and bladder spasms are common.
- Weeks 1 to 2Mouth heals
Most men are eating normally and getting around comfortably, still with the catheter.
- Weeks 2 to 3X-ray check and catheter out
An X-ray dye test checks that the repair has healed without leaks. If it has, the catheter comes out. If there is a small leak, the catheter stays about another week.
- Weeks 3 to 6Back to normal
Your stream is usually strong. Most men return to full activity and sex by about 6 weeks.
- About 3 monthsFirst check-up
A urine flow test, a bladder scan after you pee, and a review of symptoms.
- 1 yearFurther check
Most strictures that come back do so within the first 1 to 2 years, so follow-up continues during this time.
- Long termWatching your stream
If your stream slows again at any time, see your urologist early.
What it feels like
Men usually say the catheter weeks are the hardest part. The pain of the operation itself is often less than expected, and the moment a strong stream returns is a big relief, especially for men who have struggled for years.
Before surgery
Many men are tired of a weak stream and earlier procedures, and uneasy about the cheek graft and weeks with a catheter.
What helpsAsk your surgeon to show you the X-ray of your stricture and walk you through the plan. Knowing exactly what will happen makes it easier.
Waking up
The cheek can bother you more than the incision between the legs. Your mouth may feel tight and swollen, and your lip or cheek may feel numb.
What helpsIce chips, cold drinks and pain medicine on a schedule.
Eating in the first days
Chewing is sore, and hot, spicy or crunchy food stings.
What helpsSoft, cool foods. Chew on the other side. Most men are eating normally within 1 to 2 weeks.
Living with the catheter
Embarrassment, the tug of the tube, bladder spasms, and uncomfortable erections at night.
What helpsSecure the tube to your thigh, wear the leg bag under loose pants, take spasm medicine as directed, and empty the bag before it gets heavy.
Sitting
Sitting on the incision feels like sitting on a deep bruise.
What helpsUse a soft cushion, shift your weight to one side, and get up and walk often.
Catheter removal day
Nervous waiting for the X-ray result, then the first pee may sting or spray.
What helpsDrink normally. The first few pees settle quickly, and many men are amazed at how strong the stream is.
The following weeks
Some men notice a few drops of urine after they finish, or a change in sensation or feel during erections.
What helpsPressing gently behind the scrotum and sweeping forward after peeing clears the last drops. Most changes ease over months.
How well it works
Success means a strong stream that stays strong without further procedures.
- Success rates
For short bulbar strictures that are cut out and rejoined, about 9 in 10 men or more stay open over the long term. With cheek grafts, about 8 to 9 in 10 are successful at several years. Results are lower for long penile strictures, lichen sclerosus, and repairs after radiation.
- How success is checked
Your symptoms, a urine flow test and a bladder scan after you pee. If anything looks off, a cystoscopy or X-ray dye test.
- If the stricture returns
Most recurrences show up in the first 1 to 2 years, often as a thin ring that can be treated with a minor procedure.
- Long-term follow-up
Any time your stream slows again, tell your urologist early, when treatment is simplest.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Expected for 1 to 2 weeks when a cheek graft is used.
Between the legs and in the scrotum for 1 to 2 weeks.
Common while the catheter is in.
A few drops after you finish are common after bulbar repairs. Usually mild, and helped by pressing behind the scrotum.
Less common
Often a thin ring that can be treated with a minor procedure; sometimes another urethroplasty is needed.
Some men notice softer erections, a slight change in curve or length, or less feeling in the head of the penis for some months, especially after the scar is cut out. Most improve within 6 to 12 months.
The catheter stays in a little longer, and nearly all such leaks heal.
Usually improves over a few months.
A urinary or wound infection, treated with antibiotics.
From the surgical position. Usually temporary.
Rare
Uncommon. Ask your surgeon about your specific risk.
A rare but serious problem after long surgery in stirrups, called compartment syndrome. Teams limit time in the position and watch for it.
Rare after cheek graft harvest.
Rare. Walking soon after surgery lowers the risk.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- The catheter falls out, or stops draining and your bladder feels full. Call your urology team right away, and do not let anyone else put a new one in
- Heavy bleeding from the penis or incision, or swelling of the scrotum or perineum that grows quickly and feels tense
- Redness, warmth or pus at the incision
- Leg pain, swelling, numbness or weakness that is getting worse
- Mouth bleeding that does not stop after 20 minutes of firm pressure, or swelling that makes it hard to swallow
- Chest pain or trouble breathing (call 911)
Questions to ask your surgeon
- How long is my stricture, and exactly where is it?
- Will you cut out the scar and rejoin the ends, or use a graft?
- Will you need a cheek graft, and from which side?
- How many urethroplasties do you do each year?
- What success rate do you see for strictures like mine?
- Should I stop self-dilating before surgery, and for how long?
- How long will I have the catheter, and how will you check healing?
- What are the chances of changes in erections or penis length?
- Does lichen sclerosus play a part, and does it need treatment?
- If the stricture comes back, what are my options?
- When can I ride a bicycle, return to work and have sex?
Words you may hear
- Urethral stricture
- A section of scar that narrows the urethra.
- Anterior urethra
- The part of the urethra from the sphincter muscle to the tip of the penis.
- Bulbar urethra
- The section of urethra behind the scrotum, where most strictures occur.
- Penile urethra
- The section of urethra inside the penis.
- Corpus spongiosum
- The spongy tissue that wraps around the urethra and carries its blood supply.
- Excision and primary anastomosis
- Cutting out a short scar and stitching the healthy ends together.
- Buccal mucosa graft
- A strip of the lining from inside the cheek, used as a patch to widen the urethra.
- Onlay
- Laying a graft into an opened urethra as a patch.
- Retrograde urethrogram
- An X-ray taken while dye is gently put into the urethra from the tip of the penis.
- Voiding cystourethrogram
- An X-ray taken while you pee out dye that was placed in the bladder.
- Urethrotomy
- Cutting a stricture from the inside with a tiny knife through a scope.
- Lichen sclerosus
- A long-term skin condition that can scar the tip of the penis and the urethra.
- Suprapubic tube
- A catheter that drains the bladder through the lower belly.
- Uroflow
- A test that measures how fast urine comes out when you pee into a special toilet.
Common questions
Why use the inside of my cheek?
Cheek lining is tough, used to being wet, easy to take, and heals well when moved to the urethra. The cheek itself heals in 1 to 2 weeks.
Will my face look different?
No. The graft comes from inside the cheek, and there is no scar on the face. Some men notice tightness or numbness inside the cheek for a few months.
Why do I need a catheter for so long?
The catheter supports the repair and keeps urine away from it while it heals. Removing it too early could let urine leak and cause the scar to return.
I have had several urethrotomies. Is it too late?
No. Urethroplasty still works well after earlier procedures, although repeated cutting can make the scar longer and the repair more involved.
Will this affect my erections?
Some men notice changes in firmness, curve or sensation for several months, and most recover. Lasting new erection problems are uncommon.
Do I need to keep self-dilating after surgery?
Usually not. Most surgeons ask you to stop once the repair has healed, unless they advise otherwise.
Can the stricture come back after urethroplasty?
Yes, in a minority of men, most often in the first 1 to 2 years. Many of these are thin rings that can be treated with a small procedure.
Sources this page draws on
- American Urological Association (AUA), Urethral Stricture: AUA Guideline
- European Association of Urology (EAU), Guidelines on Urethral Strictures
- Société Internationale d'Urologie (SIU) and International Consultation on Urological Diseases (ICUD), Urethral Strictures: SIU/ICUD Consultation (2014)
- Urology Care Foundation, Urethral Stricture Disease
- MedlinePlus, U.S. National Library of Medicine, Urethral stricture
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.