What Is Urethroplasty?

"Can't the narrowing just be stretched?" If you've been offered a urethroplasty, there's a good chance that question has crossed your mind — so this guide is built around it, and the questions that usually follow. A urethroplasty is an operation that rebuilds a narrowed section of the urethra, the tube that carries urine out of the body. The video at the top of this page, "Distal Urethroplasty with Dorsal Dartos Flap" (just under four minutes), is a surgical recording of one version of it: a repair near the far end of the urethra — the distal urethra — in which a flap of nearby tissue, the dartos, is used to support the rebuilt section. What follows answers, one by one, the questions that recording tends to raise.

First question: what exactly has narrowed?

Healthy urethral tissue is soft and stretchy, so the tube opens easily as urine passes. A stricture is a section where scar tissue has formed instead — after an injury, an infection, inflammation, or earlier instrumentation, for example — and scar doesn't stretch the way healthy tissue does. The narrowed section slows the stream, and over time you might notice straining, a sprayed or split stream, dribbling afterwards, or a feeling that the bladder never quite empties. Before any repair is planned, the team needs to know exactly where the narrowing sits and how long it is. That mapping usually involves a camera inspection of the urethra and bladder — the test we walk through in our guide to cystoscopy — sometimes paired with X-ray imaging while dye outlines the tube. The answers decide which operation, if any, fits.

So why not just stretch it, or cut it open from inside?

Sometimes that is the first step, and for a short, first-time narrowing it can work well. Dilatation gently stretches the scarred section wider; an internal urethrotomy cuts the scar from inside the tube with a scope. The catch is the biology: you're asking scar tissue to behave like healthy tissue, and scar has a habit of shrinking back as it heals. When a narrowing keeps returning after those simpler treatments — or when it's long, dense, or awkwardly placed from the start — stretching it again is unlikely to hold. That's the point where rebuilding earns its place. Urethroplasty removes or rebuilds the scarred section itself rather than persuading it wider, which is why urologists generally think of it as the more durable fix. Which route suits you is a judgement your specialist makes from the map of your stricture, not from a rule book.

What does the rebuilding actually involve?

You'll be asleep under a general anaesthetic. Broadly, there are two families of repair. In an excision repair, suited to shorter strictures, the surgeon removes the scarred segment altogether and joins the two healthy ends back together. In a substitution repair, used when the narrowed section is too long for that, the channel is widened with added tissue — often a graft taken from the inside of the cheek, or a flap of nearby skin and its underlying tissue kept attached to its own blood supply. The video above shows the flap idea: in that distal repair, the dartos — the soft tissue layer just under the skin — is turned over the rebuilt section as a supporting flap, so the new channel has a well-supplied bed to heal against. Strictures further back in the urethra bring their own variations; our longer video on "Posterior Urethral Strictures Associated with Urinary Incontinence after Prostatectomy Management" (about ten minutes) covers that harder, post-prostate-surgery situation and how it's managed. However your repair is built, a soft catheter is left in the urethra at the end — it's the scaffold the new join heals around.

And recovery — what does the catheter mean for daily life?

Most people go home with that catheter in place, draining into a bag you can strap to the leg and largely get on with life around. It typically stays for a few weeks, while the rebuilt section heals; before it comes out, the team may take an X-ray with dye around the catheter to check the join is sealed. Expect some soreness around the operation site, and take things gently — heavy straining and straddle activities like cycling are usually off the list until your team says otherwise. Follow-up doesn't end when the catheter is removed: you'll have flow checks and reviews over the following months, because spotting any re-narrowing early makes it far easier to deal with. The same camera family that mapped the stricture can check other parts of the urinary tract too — our article on ureteroscopy shows how scopes are used further up, in the ureter and kidney. Do get checked promptly, at any stage, for fever, worsening pain, bleeding that isn't settling, swelling that keeps growing, or a catheter that stops draining — none of those should be waited out at home.

References & further reading

• MedlinePlus — Urethral stricture (Medical Encyclopedia): https://medlineplus.gov/ency/article/001271.htm
• MedlinePlus — Urethral Disorders: https://medlineplus.gov/urethraldisorders.html
• National Institute of Diabetes and Digestive and Kidney Diseases — Cystoscopy & Ureteroscopy: https://www.niddk.nih.gov/health-information/diagnostic-tests/cystoscopy-ureteroscopy

MedicalVideos.com has published trusted medical videos since 2007. The site was founded by Dr. Mohamed Ibrahim, MD, PhD — physician-scientist.

Frequently Asked Questions

Is urethroplasty the same as dilatation?

No. Dilatation stretches a narrowed section wider from inside, while urethroplasty is an operation that removes or rebuilds the scarred section itself. Dilatation is simpler and is often tried first; urethroplasty is usually considered when a narrowing keeps coming back or is too long or dense for stretching to hold.

Where does the tissue for a graft or flap come from?

It depends on the repair. A graft is often taken from the lining inside the cheek, which heals quickly and suits the moist environment of the urethra. A flap, like the dartos flap in the video on this page, uses nearby tissue that stays attached to its own blood supply. Your surgeon will explain which approach your stricture needs.

Will I have a catheter after urethroplasty?

Yes, almost always for a time. The catheter drains the bladder and acts as a scaffold while the rebuilt section heals. It commonly stays in for a few weeks, and the team may check the join with a dye X-ray before removing it.

Can a stricture come back after urethroplasty?

It can, though rebuilding the scarred section is intended to be more durable than repeatedly stretching it. That's why follow-up flow checks continue after the operation — a re-narrowing caught early is much easier to treat.

Is urethroplasty only for men?

Strictures are far more common in men because the male urethra is much longer, and most urethroplasty is performed in men. Urethral narrowing does occur in women too, and the same reconstructive principles can apply; your specialist will advise on your own situation.

Dr. Mohamed Ibrahim, MD, PhD

Physician-scientist · Founder, MedicalVideos.com

Dr. Ibrahim founded MedicalVideos.com in 2007 to make medical and surgical education freely accessible to students, clinicians, and patients.

Last reviewed: 11/09/26

This article is for general education only and is not medical advice. It does not replace consultation with a qualified clinician. Fever, worsening pain, bleeding that is not settling, or a catheter that stops draining after urethral surgery should be assessed promptly.