Urethrectomy
What is a Urethrectomy?
A urethrectomy is a surgical procedure to remove all or part of the urethra, the tube that carries urine from the bladder to the outside of the body. In men, the urethra also carries semen during ejaculation. This operation is most commonly performed to treat urethral cancer or to reduce the risk of cancer developing or recurring in the urethra after bladder removal (radical cystectomy) for bladder cancer. In selected cases, it may also be performed for other complex urethral conditions.
What are the Benefits of a Urethrectomy?
When recommended, a urethrectomy can provide effective treatment for serious urological conditions.
Benefits include:
- Removes cancerous or high-risk urethral tissue
- Reduces the risk of cancer recurrence in the urethra
- Helps achieve complete cancer removal
- Preserves kidney function by maintaining appropriate urinary drainage
- May improve long-term cancer control
- Can be performed alongside other major urological procedures when appropriate
- Allows detailed examination of the removed tissue
- Forms part of a comprehensive treatment plan for advanced urological cancers
When is a Urethrectomy Recommended?
Your urological surgeon may recommend a urethrectomy in specific clinical situations.
Common indications include:
- Primary urethral cancer
- Cancer involving the urethra after bladder cancer
- High risk of urethral recurrence following radical cystectomy
- Urothelial carcinoma involving the prostatic urethra
- Selected recurrent or persistent urethral tumours
- Rare complex urethral conditions where other treatments are unsuitable
The decision to perform a urethrectomy depends on the location of the disease, cancer stage, previous treatments, and your overall health.
What does Preparation for a Urethrectomy Involve?
Before surgery, your healthcare team will carry out a comprehensive assessment to plan the procedure safely.
Preparation may include:
- Medical history and physical examination
- Blood and urine tests
- CT scan or MRI
- Flexible cystoscopy or urethroscopy
- Biopsy confirmation where appropriate
- Review of current medications, including blood-thinning medicines
- Pre-operative anaesthetic assessment
- Discussion of the operation, recovery, and potential risks
- Fasting before surgery
Patients undergoing urethrectomy as part of bladder cancer treatment may also undergo additional imaging and multidisciplinary review before surgery.
How is a Urethrectomy Performed?
A urethrectomy is performed under general anaesthetic and may be carried out as a standalone procedure or in combination with radical cystectomy.
The surgeon usually makes an incision in the perineum, the area between the scrotum and the anus, to access the urethra. Depending on the reason for surgery and the extent of disease, part or all of the urethra is carefully separated from the surrounding tissues and removed. In men undergoing complete urethrectomy, the urethra is removed from the prostate to the tip of the penis while preserving surrounding structures whenever possible.
If the procedure is performed alongside bladder removal, the urethrectomy forms part of the overall cancer operation. Nearby lymph nodes or additional tissue may also be removed if required for cancer treatment.
Once the urethra has been removed, the surgeon checks for bleeding, places a wound drain if necessary, and closes the incision with sutures. Patients who have previously undergone urinary diversion, such as an ileal conduit, continue to pass urine through their existing urinary diversion after surgery.
What to Expect during Recovery after a Urethrectomy?
Recovery varies depending on whether the urethrectomy is performed alone or alongside other major surgery.
During recovery, you may experience:
- A hospital stay of several days
- Mild to moderate pain around the incision
- Temporary bruising and swelling
- A surgical drain for a short period
- Gradual return to walking and light activities
- Avoidance of heavy lifting for approximately six weeks
- Follow-up appointments to review healing and pathology results
If the surgery is performed for cancer, ongoing surveillance and, in some cases, additional treatment may be recommended based on the final pathology findings.
What are the Risks and Complications of a Urethrectomy?
A urethrectomy is a major urological operation, and, like all surgery, it carries potential risks.
Possible complications include:
- Bleeding
- Infection
- Wound healing problems
- Pain or discomfort around the incision
- Blood clots in the legs or lungs
- Injury to nearby structures, including the rectum, although uncommon
- Erectile dysfunction in men
- Need for additional cancer treatment
- Cancer recurrence
- Anaesthetic-related complications
Your urological surgeon will explain why a urethrectomy is recommended in your individual case, discuss the expected benefits and potential risks, and develop a personalised treatment and follow-up plan to achieve the best possible oncological and functional outcome.