Prof. Dr. Emel Akoğlu
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- 57+years exp.
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Kidney & Bladder
Urethroplasty
What urethroplasty is, how it repairs a urethral stricture, how it differs from dilation and urethrotomy, which techniques are used (end-to-end repair, buccal graft, staged repair), what the evidence says about success, approximate costs in Turkey against the UK, US and Germany, catheter and recovery, risks and how to choose a hospital.
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Prof. Dr. Zerrin Biçik Bahçebaşı
UrologyVerified
- 37+years exp.
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Urethroplasty in Turkey: what it is and how it works
Urethroplasty is open surgery to repair a narrowed urethra, the tube that carries urine from the bladder out of the body. The narrowing, called a urethral stricture, is a scar that blocks or slows the flow. In urethroplasty the surgeon either removes the scarred section and joins the healthy ends together, or widens the segment with a patch of tissue, often taken from inside the cheek. The aim is to rebuild a lasting channel rather than to stretch or cut the scar, which tends to return.
The operation is done mostly in men, because the male urethra is long and prone to scarring. It is considered the definitive treatment for stricture, and it is usually recommended after simple dilation or cutting has failed or when the stricture is long, dense or complex. This guide explains how it works, what the evidence says, what it costs in Turkey against the UK, US and Germany, and what recovery involves. For the wider field see our urology treatments in Turkey.
What is a urethral stricture, and what are the symptoms?
A stricture forms when injury, infection or inflammation leaves scar tissue that tightens inside the urethra. Common causes are a fall astride a bar or bicycle frame, pelvic fracture, previous catheters or endoscopic surgery, sexually transmitted infection, a skin condition called lichen sclerosus and, in some men, hypospadias surgery in childhood. In many cases no cause is found.
Typical symptoms include a slow, thin or spraying stream, straining, a feeling that the bladder does not empty, dribbling after urinating, repeated urinary infections and, sometimes, a sudden inability to pass urine. Because these symptoms resemble an enlarged prostate, the diagnosis is made with tests: a flow-rate measurement, a retrograde urethrogram (an X-ray with contrast dye in the urethra) and a flexible cystoscopy to see the narrowing and judge its length and position.
Dilation, urethrotomy or urethroplasty: which treatment suits which stricture?
There are three main options, and the choice depends on the length and position of the stricture and on whether earlier treatment has failed.
| Treatment | Best suited to | Typical limits |
|---|---|---|
| Dilation (stretching) | A short, first-time stricture; temporary relief | The scar often returns; repeated dilations can cause more scarring |
| Urethrotomy (cutting the scar through a scope) | A short, first-time stricture under about 1.5 to 2 cm | High recurrence, especially after a second attempt |
| Urethroplasty (open repair) | Recurrent, long, dense or complex strictures | Larger operation; catheter for about 2 to 3 weeks; specialist surgeon needed |
European Association of Urology guidelines suggest that men with a recurrent stricture after one dilation or urethrotomy should be offered urethroplasty, because repeating the same procedure rarely gives a lasting result. Some men also develop strictures after prostate surgery such as TURP or TUIP, and a urologist will check whether the narrowing is in the urethra or at the bladder neck.
Which urethroplasty technique will be used?
The surgeon chooses the technique on the basis of the stricture's length, position and condition of the surrounding tissue.
- Excision and primary anastomosis (end-to-end repair): the scarred segment is cut out and the healthy ends are stitched together. It suits short strictures in the bulbar urethra, typically up to about 2 cm, and has a high long-term success rate.
- Buccal mucosa graft urethroplasty: a strip of lining from the inside of the cheek is sewn in as a patch to widen the urethra. It is the most used graft because mouth lining tolerates moisture and heals well. It suits longer strictures, and the patch is placed on the upper (dorsal) or underside (ventral) of the urethra depending on the surgeon's technique.
- Penile skin flap: in penile strictures, a flap of local skin may be used where a graft is not suitable.
- Staged urethroplasty: in very scarred or diseased urethras, such as those with lichen sclerosus, the repair is done in two operations a few months apart.
Each has strengths and limits, and a surgeon should explain why a certain approach is suggested for you. Because the operation is technically demanding, results depend heavily on the surgeon's experience with it.
Does urethroplasty work? What the evidence says
Of the stricture treatments, urethroplasty has the most durable long-term results. Published series from specialist centres report that most men, commonly around 80 to 90 per cent in the bulbar urethra, remain free of recurrence at several years, and results are lower in long, penile or complex strictures. Nevertheless, success depends on stricture length, location, the cause (lichen sclerosus is harder), previous operations, smoking and the surgeon's volume. Recurrence can happen months or years later, so follow-up with flow tests is part of care. Be cautious of any clinic that promises a permanent cure.
Urethroplasty cost in Turkey compared with the UK, US and Germany
The figures below are approximate ranges, not hospital quotes. The price depends on the technique, the length of the stricture, the need for a graft, the length of stay and what the package includes. The hospital confirms its own price in a written quote.
| Country | Approximate cost range |
|---|---|
| Turkey | €3,500 – €9,500 |
| United Kingdom | €7,500 – €16,000 |
| United States | €15,000 – €45,000 |
| Germany | €6,500 – €15,000 |
What changes the price: a simple end-to-end repair costs less than a graft or a two-stage repair, a mouth graft adds a second operative site, hospital stay is longer for complex cases, and imaging and tests may be needed before surgery. A transparent package lists the consultation, urethrogram and cystoscopy review, the surgeon and anaesthetist, the hospital stay, the catheter, medication and a post-operative urethrogram. Ask whether a second stage or later revision is covered. The page on how it works explains how written quotes are produced.
How is the operation done, step by step?
Urethroplasty is done under general anaesthesia, sometimes combined with a regional block, and takes about two to four hours. You lie on your back with the legs supported. The surgeon makes an incision in the perineum, the area between the scrotum and the anus, or along the shaft of the penis for a penile stricture, and exposes the urethra. The scarred segment is excised or opened along its length. For a buccal graft, a second surgeon or the same team harvests a strip from the inside of the cheek, which is closed or left to heal. The graft or the ends are sutured in place over a catheter and the tissue is closed in layers. A drain may be left for a day or two. You stay in hospital for one to three nights.
Catheter, recovery and the trip step by step
Recovery is gradual. A typical timeline is:
- Days 1 to 3: bed rest and walking short distances, with pain relief and antibiotics. Swelling and bruising around the perineum are common.
- Weeks 1 to 2: a urethral catheter and perhaps a suprapubic tube stay in place. Light walking only; sitting can be uncomfortable, so a cushion helps. Mouth discomfort from the graft site eases over one to two weeks.
- Weeks 2 to 3: many surgeons arrange a contrast X-ray (voiding cystourethrogram) to check the repair before the catheter is removed. Urination restarts.
- Weeks 4 to 6: return to desk work is normal from about two to three weeks; avoid straddling activities such as cycling and heavy lifting until the surgeon agrees.
- Months 3 to 12: flow tests and review. Sexual activity usually resumes after four to six weeks, with the surgeon's agreement.
Because the catheter normally stays for about two to three weeks, plan to stay in Turkey for 10 to 21 days so that the X-ray check and catheter removal can be done by the operating team. Some hospitals discharge you with a catheter for removal at home; agree this plan in writing before you book.
What are the risks of urethroplasty?
The NHS and the European Association of Urology list the main risks as stricture recurrence, infection, bleeding or a collection of blood, wound problems, a poor urine stream or dribbling after urinating, and the usual risks of anaesthesia. Some men notice temporary numbness around the perineum or scrotum, and a curve or shortening of an erection is possible after penile surgery. Erectile function is generally preserved, though a small number of men report a change, and ejaculation may feel different. A graft from the cheek can cause tightness, numbness or pain in the mouth that usually settles within weeks. Fever, increasing pain, heavy bleeding or being unable to pass urine after the catheter is removed need urgent care.
Who is a good candidate, and how do I choose a surgeon?
Good candidates are men with a proven stricture, confirmed by urethrogram and cystoscopy, who have had previous treatment fail or who have a long or dense stricture. Smoking, diabetes and obesity affect healing, so stopping smoking is advised. Choose a reconstructive urologist who performs urethroplasty regularly, in a licensed hospital with an anaesthetist and the ability to place a graft. You should receive a written plan based on your own scans. Red flags include a quote without images, a promise of a one-visit cure, no named surgeon, no X-ray before catheter removal and no follow-up plan at home. Send your reports through our free quote page.
What should I ask the clinic before booking?
- Where is my stricture, how long is it and what technique do you suggest?
- How many urethroplasties does the surgeon perform each year, and what are the results?
- Will a graft be taken from my mouth, and what should I expect there?
- How long will the catheter stay, and who removes it?
- Is a contrast X-ray before catheter removal included?
- What if the stricture returns, and is a revision covered?
- How long should I stay in Turkey before flying home?
Hospitals with Urology in Turkey
Frequently asked questions
Urethroplasty is open surgery that repairs a narrowed urethra. The surgeon removes the scarred section and rejoins the healthy ends or widens the channel with a patch of tissue, often taken from inside the cheek.
It has the most durable results of the stricture treatments, with most men staying free of recurrence for years, particularly after short bulbar repairs. Long, penile or complex strictures have lower success, and no one can guarantee a cure.
Approximate ranges are €3,500 to €9,500 in Turkey, against about €7,500 to €16,000 in the UK. The price depends on the technique, graft use, stay and package contents; the hospital confirms it in a written quote.
You are asleep during the operation. Afterwards there is soreness, swelling and bruising around the perineum, and a sore mouth if a cheek graft is used. Painkillers control it, and most people feel much better after two weeks.
Usually about two to three weeks. Many surgeons take an X-ray with contrast dye before removing it to check that the repair has healed, so the exact date depends on that result and on how you are healing.
Most men return to desk work after two to three weeks, avoid heavy lifting and cycling for about six weeks and are reviewed with flow tests over the following year. Full healing takes several months.
For recurrent or long strictures, urethroplasty gives more lasting results, which is why guidelines suggest it after a failed first attempt. Dilation and urethrotomy are simpler operations, but the scar often returns, so repeating them rarely helps.
Yes, though it is uncommon after a successful repair. It can return months or years later, so flow tests are part of follow-up. A revision, sometimes by a different technique, may then be needed, so ask whether it is covered.
Erections are usually preserved, though a few men notice changes, and ejaculation can feel different at first. Fertility is not generally affected, but discuss your own situation and any penile curve with the surgeon beforehand.
Plan about 10 to 21 days, depending on whether the catheter is removed in Turkey. The surgeon wants to check the repair by X-ray and remove the catheter before you fly, so agree this plan in writing.
Patient stories