Most urethral strictures occur in the part of the urethra between the bottom of the penis and the prostate. This part of the urethra travel underneath of the scrotum and underneath the skin between your legs. For that reason, the incision is generally directly between then legs. All sutures used to close this incision are dissolvable, and do not need to be removed at a later date. Approximately two days after surgery, it is OK to shower. Allowing soapy water to run over the incision is advisable. The incision should not be scrubbed vigorously.
No ointments such as Neosporin are required, unless you are directed to do otherwise by your physician. You may find it useful to place a dry gauze over your incision in the early days after surgery, as a small amount of spotting with blood is not uncommon and may soil your underwear.
Walking is to be encouraged after surgery. Vigorous exercise such as running and weight lifting is generally avoided in the first few weeks after surgery and should not be done until cleared by your surgeon. Cycling should be especially avoided until the wound has healed and you are cleared to do so by your surgeon.
Your sharp incisional pain will improve dramatically in the first seven days after surgery. You will not feel completely “comfortable” until your catheter is removed. It is not uncommon for men to have the following complaints from the incision after surgery: scrotal numbness, mild pins and needle sensation of the scrotum, and dull testicular aches.
Items that would require a call to your physician include the following: a wound separation in which the stitched pull apart, having a high volume bloody drainage that is saturating your underwear or gauze in a short period of time, pus-like material draining from your wound, increasing redness of the incision with fevers over 101.5. These are all very rare events.
Standard of care is to leave a catheter in after your urethroplasty. The duration that the catheter stays in place ranges from 1-4 weeks, and depends on the type of surgery done in addition to surgeon preference. It is OK to shower with your catheter in place. Do not bathe or submerge your catheter is stagnant water.
Catheters come with two types of drainage bags: leg and night bags. It makes no difference which bag you use, but in general leg bags are easy to conceal underneath lose fitting pants and are generally used during waking hours. While sleeping, most patients prefer a night (larger) bag that does not require to be emptied while you sleep.
It is not uncommon for patient to experience “bladder spasms” while the catheter is in place. A bladder spasm is a bladder “cramp” in which your bladder contracts due to irritation of the bladder with the catheter in place. This causes the sensation of needing to urinate, and it is not uncommon for bladder spasms to cause leakage of urine around the side of the catheter when this occurs. It is also not uncommon for urine to be expelled around the sides of the catheter when you strain to have a bowel movement. Constipation is very common while you are taking pain medication, and using an over the counter stool softener may help this problem.
Blood in the urine is also not infrequent after a urethroplasty. More commonly, bleeding occurs around the sides of the catheter in the early days after surgery can occur. As long as the blood around the catheter is not saturating your undergarments in a short period of time, this is not concerning. If heavy, please call your physician.
Patients will often experience discharge of mucous around the catheter insertion site, and this becomes more pronounce the longer it is in place. Mucous glands exist within the “head” of the penis which become overactive while the catheter is in place. Many patients fear that this is pus as it appears yellow in color. As long this finding is not associated with fevers over 101.5 or significant redness of the penis, you should not be alarmed.
If your bladder feels full and your catheter is not draining for an extended period of time, please call your physician.
It is common for patients to inquire about erections while a catheter is in place. For men with good erectile function, erections are common even with a catheter is in place. These generally occur during sleep. These are not detrimental to the surgical repair, but they can be uncomfortable. Medications to prevent erections while a catheter is in place are not routinely given.