Urologie

You and your urologist have chosen a urethroplasty. In this brochure you will find all the practical matters that are important around the operation.

Before the operation

You will be placed on the waiting list for urethroplasty. The planner will call you approximately 2 weeks before the date of the operation.

• Have you had symptoms in the 2 weeks before the operation that may indicate a bladder infection? Please contact the urology department to schedule a urine test.
• Are you using blood thinners? Discuss with your healthcare provider whether these should be stopped temporarily and from when.

The day of the operation

Location

On the day of the operation, you will come to the agreed location:

• Amsterdam UMC, location VUMC: de Boelelaan 1117 in Amsterdam.
  You will come to the Urology department 4B.
• Bosch en Duin: Biltseweg 14, Bosch en Duin.

• Take 1000 mg paracetamol before the operation and bring tight fitting underwear for after the operation.

The operation

• The operation itself takes about 2.5 hours. After a stay in the recovery room you can go home.

Discharge

• Upon your discharge you will be given prescriptions for medication:
• Oxybutinin: you only need to take this for bladder cramps. You will notice this by a cramping feeling in the lower abdomen. Sometimes urine will run along the catheter.
• Antibiotics (tablet): You will take this on the morning of the check-up X-ray.

After the operation

Wound

After the operation, you will have a wound between the scrotum and the anus (the perineum), the skin is closed with dissolvable stitches and therefore does not need to be removed. The healing of the wound and the dissolving of the stitches takes two to three weeks. In the beginning, you may experience blood in your urine. This is normal and is not harmful. You may not take a bath, swim or go to the sauna for the first two weeks. You may shower from 24 hours after the operation. Make sure that you dry the wound well after showering. Wipe from front to back after defecation to prevent contamination of the wound.

The wound should look calm. Pink skin and red watery discharge are normal. Signs of infection are: pus, fiery redness, severe swelling and fever. In that case, please contact the urology outpatient clinic for the nurse or nurse practitioner.

Have you had surgery on your cheek or tongue for replacement mucosa? The wound in the cheek will close after a few days. However, the cheek may still feel tight. In principle, there are no dietary restrictions. Popsicles can relieve the pain, as can rinsing with mouthwash (such as PerioAid).

Pain and rest

You may take paracetamol from one day before the operation. The maximum amount per day is 4x1000 mg and can be reduced at your own discretion.

In addition, the pain will be less when taking enough rest. In order to give the surgical area enough rest, it is important to avoid pressure on the groin for the first 6 weeks. Avoid the following activities: sitting for long periods, cycling, driving a car or motorcycle for long periods and horse riding.

Do not lift heavy objects and do not do heavy work. ‘Heavy’ means having to use your abdominal muscles. This puts pressure on the surgical area and can even damage the wound and the urethra.

You may sit on the wound, but listen to your body: do not exceed a pain threshold. To prevent swelling, it is advisable to wear tight fitting underwear. You may wear a thin, soft sanitary pad in your underwear for comfort.

Catheter care

After the operation, you will have a catheter for 2-3 weeks. After the operation, you will receive a package containing the necessary items. This includes:

• A day bag: a smaller bag that you can wear discreetly under your pants.
• A night bag: a larger bag that can hold more urine during the night.

One bag will last you about 5 days. The bags can be rinsed to prevent dirt from accumulating.

A few tips:

• Make sure the catheter bag hangs lower than the bladder for a good flow.
• Make sure the catheter tube is not under tension or kinked.
• The end of the penis can be lubricated with some Vaseline to prevent friction between the penis and the catheter tube.
• You may suffer from bladder cramps: a cramping pain in the lower abdomen, urine running along the catheter, a feeling of urgency. The bladder reacts to the balloon that anchors the catheter. If you experience this, please contact the outpatient clinic or the nurse practitioner. You can be given medication that calms the bladder.
• If the urine is dark (tea-colored), this is a sign that you need to drink a little more. If the urine is pink, there is a small amount of blood in the urine, this is not a problem. Is the urine dark red or are there clots in the tube or bag? Please contact us.

When is the catheter removed?

A retrograde urethrogram (X-RUG) is made 2-3 weeks after the surgery to check whether the urethra has healed properly. urethra may also take longer to heal, in which case you will keep the catheter in place for longer than the expected two to three weeks.

Sexuality

After the catheter has been removed, you can be sexually active again. In principle, urethroplasty has no effect on the sexual function of the penis. However, surgery can affect your mental relationship with sex. Would you like to talk about this? Discuss this with your urologist or nurse practitioner. You can also visit a sexologist. This is a healthcare professional who specializes in counseling sexual complaints. You can find more information about this at www.nvvs.info.

Contacting the hospital

You must contact the hospital immediately if you have the following complaints, even outside office hours:

• Fever above 38.5ºC.
• Fiery red and warm or oozing wound.
• Persistent severe pain in the surgical area.
• Little urine, even if you drink a lot.
• Bloody urine with clots.
• Problems with the catheter such as bladder cramps or blockage. The catheter may only be removed in consultation with your doctor.

Information

If you are worried or have questions about a diagnosis, examination or treatment, it is best to contact your healthcare provider by sending him or her a message via the My File environment.

You can contact the Urology department's nursing consultation hours by telephone on 020 444 11 03. The nursing consultation hours are from Monday to Friday from 8:30 to 9:30.

For urgent matters, you can contact the hospital:

• During office hours: call the nursing consultation hours 020 444 11 03.
• Outside office hours: call the hospital's general number 020 444 44 44 and ask for the urologist on duty

You can also visit our website: www.amsterdamumc.nl Specialismen Urologie

Finally

Amsterdam UMC is a university medical centre where medical specialists are trained. They hold independent consultations and assist with operations. This may mean that you have an appointment with your urologist and meet another doctor. This is an assistant in training to become a specialist (AIOS). He or she works independently, but always under the responsibility of your urologist. If you prefer to speak to your own urologist, you can indicate this when you make an appointment. We will try to take your wishes into account.

This brochure contains general information. It is intended as additional information in addition to the conversation with your treating physician.