Urethrolysis

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Urethrolysis an operation carried out to correct obstruction to passing urine after surgery for stress incontinence of urine (leakage of urine on coughing and sneezing).

The operation aims to free the urethra, so that urine can flow out easily. It can be done vaginally, abdominally (through a cut across the tummy) or laparoscopically (through key hole surgery).

Vaginal and abdominal operations can be carried out under general or spinal anaesthesia. The laparoscopic approach requires general anaesthesia.

Why do I need urethrolysis?

The operation is intended to improve passing urine. This will help you with problems caused by difficulty in emptying the bladder, like dribbling at the end of passing urine, pain, repeat and / or urgent need to pass urine, urinary leakage and repeat urinary tract infections.

What can I expect before the operation?

At your pre operative assessment and on your admission day, the nurse will go through your hospital stay and explain your operation. Please do let us know about any concerns you have, or if there is any information you think we should know, that will make your stay with us more comfortable.

Before coming into hospital you will need to make alternative arrangements for any caring or other responsibilities that you have during your admission and your recovery period at home.

You will see an anaesthetist and the doctor performing the surgery before you go to theatre. It is not unusual to feel anxious; the nursing staff will gladly discuss with you how you are feeling and talk you through your emotions.

If you have not already signed the consent form, the doctor will go through it with you before you go to theatre.

You will be asked for permission to enter your data on the national database for continence and prolapse surgery. This is a quality control measure to compare the safety and effectiveness of such procedures at the hospital against other units in the country.

If you have not already completed a quality of life questionnaire, you will be asked to do so before surgery.

You will be given a copy to complete and bring with you when you attend your follow up appointment after surgery. This will assessing the benefit of surgery for you.

What does the operation involve?

If the operation is to be done vaginally, it will entail a cut inside the vagina.

If the operation is to be done abdominally, it will entail a cut through the tummy wall. This cut is usually across the tummy, but it might have to be vertical (up/down).

If the operation is to be done laparoscopically, it will entail three small cuts across the tummy. One of these cuts is made in the umbilicus (belly button). In patients who had previous surgery with open cuts across the tummy, this cut may have to be below the chest wall (rib cage) on the left side. The other two cuts are lower down on either side.

Regardless of the route, the urethra will be mobilised from its fixed position, to have more mobility. The cuts made will then be closed, with dissolvable stitches.

Which of these three approaches will I have?

The choice between the three approaches will depend on the operation(s) you had before and whether key hole surgery is possible or not. This will be discussed with you before any planned is agreed with you.

What are the risks?

There are risks with any operation but these are small.

The main risks associated with a urethrolysis are:

Common risks:

• Postoperative pain
• Urinary tract infection. This may happen as a result of passing a catheter to drain the bladder and is treated with antibiotics
• Wound infection, which may require antibiotics
• Bruising and delayed wound healing

 Uncommon risks:

• Pelvic abscess or infection
•  Venous thrombosis and pulmonary embolism (blood clot in leg / lung) can happen after any major operation. You will be asked to wear elastic stockings and given medication to prevent these clots
• Hernia at site of entry
• Haemorrhage requiring blood transfusion. Sometimes, bleeding only becomes apparent after surgery and requires returning back to theatre
• Whilst the operation may improve the ability to pass urine, there is small chance stress incontinence of urine may return. This may improve with pelvic floor muscle training, but might require further surgery
• The bladder and/or bowel rarely get injured during the operation. Any injury is repaired at the time. If such injury is not identified and repaired at the time, there is a risk of fistula, but this is extremely rare
• The operation may fail or the problem with passing urine may reoccur with time

In order for you to make an informed choice about your surgery please ask one of the doctors or nurses if you have any questions about the operation before signing the consent form. What are the risks?

What can I expect after the operation?

As you come round from the anaesthetic, you may experience episodes of pain or nausea. Please let the nursing staff know and they will assess you and take appropriate action.

A small drain may be placed in the abdominal wound to remove any excess blood.

A catheter might be inserted to drain the bladder. This will save you having to go to the toilet, till you are fully mobile after the operation.

You may have a drip to give you fluids, though you will be able to eat and drink normally.

You may have a Patient Controlled Analgesia (PCA pump) to control your pain. This is not common and will be discussed with you before the operation by the anaesthetist.

The nurses will assess you regularly to ensure that the PCA is effective. We will use a pain score to assess your pain 0 to 10; 0 No Pain, 10 Very Strong Pain.

Your nurse will be checking your blood pressure, pulse, breathing, temperature, monitoring the wound across your abdomen and checking for any vaginal bleeding. S/he will also ask you to move from side to side and to do leg and breathing exercises. This will help prevent any pressure damage, blood clots in legs or lungs or chest infection.

The first 12 hours after the operation

You can expect pain and discomfort in your lower abdomen for the first few days after the operation and will be given pain killers to help control this.

Day 1 after the operation

The drain, drip and catheter that drains the bladder are usually removed the next day.

The nursing staff will assist with washing as necessary and encourage early mobilisation. We would normally expect you to sit out of bed and begin to walk around the day after your operation.

You will be able to go home when you are passing urine without difficulty. You will be asked to pass urine in a jug and will have a scan to measure how much urine is left in the bladder. It is advisable to forget that you need to pass urine and drink and walk as you would normally do. This helps your bladder to work as normal.

You will have a dressing on the wound across your abdomen that will be removed the day after your operation and you will be able to shower.

You may also find it difficult to open your bowels at first, you will be given mild laxatives to soften your stools and prevent constipation and straining.

What about going home?

You will be seen and assessed by the Gynaecology team the following day to check on your recovery and decisions will be made about your care, this information will be shared with you. You may then be able to go home. Please feel free to ask questions about your operation and recovery at any time.

The average length of stay following urethrolysis is 1 to 2 days. In most instances you can go home the following day. As you physically recover from your operation, the nursing team will discuss your convalescence. To ensure you have a good recovery you should take note of the following:

What about follow up?

You will be invited for follow up, usually at Lewes Victoria Hospital about 12 weeks after surgery. During this follow up appointment, your symptoms will be reviewed and you will be examined to assess wound healing.

If you have problems before this you can either contact your doctor or contact the hospital to bring the appointment forwards.

Are there any alternatives to having urethrolysis?

You have been counselled about, and probably tried, intermittent self catheterisation before urethrolysis was considered. You may have tried medication for overactive bladder and / or antibiotics for urinary tract infections.

Who can I contact with any concerns or questions?

 If you have any problems or questions, you can contact:

References and useful links:

Continence Matters: Urethrolysis

If you do not understand this leaflet, we can arrange for an interpreter.

This information leaflet has been produced by Dr. Sharif Ismail, Consultant Subspecialist Urogynaecologist.

This information leaflet has been approved at the Clinical Governance and Safety and Quality Meetings of the Department of Obstetrics and Gynaecology as well as University Hospitals Sussex NHS Trust Carer and Patient Information Group (CPIG).