Urethrectomy (removal of the male urethra or water pipe)

What is the evidence base for this information?

This leaflet includes advice from consensus panels, the British Association of Urological Surgeons, the Department of Health and evidence based sources; it is, therefore, a reflection of best practice in the UK.

It is intended to supplement any advice you may already have been given by your urologist or nurse specialist as well as the surgical team at Addenbrookes. Alternative treatments are outlined below and can be discussed in more detail with your urologist or specialist nurse.

What does the procedure involve?

Removal of the male urethra (water pipe) because of cancer or the risk of cancer development usually performed through an incision in the perineum (behind the scrotum).

What are the alternatives to this procedure?

Radiotherapy to try to kill or prevent cancer in the urethra, conservative treatment.

What should I expect before the procedure?

If you are taking anticoagulation medication (sometimes referred to as blood thinning medication) on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits.

You will usually be admitted on the day before surgery. Your general fitness, to screen for the carriage of MRSA will be assessed and sometimes some baseline investigations performed prior to your admission. This can, on occasions, be done by telephone or you may be asked to attend a pre-admission clinic approximately 14 days before your admission, depending on your medical history. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and your named nurse.

You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.

Please be sure to inform your urologist in advance of your surgery if you have any of the following:

• an artificial heart valve
• a coronary artery stent
• a heart pacemaker or defibrillator
• an artificial joint
• an artificial blood vessel graft
• a neurosurgical shunt
• any other implanted foreign body
• a prescription for Warfarin, Aspirin, Rivaroxaban, Dabigatran, Apixaban, Edoxaban, Clopidogrel or Ticagrelor, or use low molecular weight heparin injections (LMWH) to treat or prevent blood clots.
• a previous or current MRSA infection
• high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human derived growth hormone)

What happens during the procedure?

Normally a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain after the operation. You will usually be given injectable antibiotics before the procedure to prevent infection, after checking for any allergies.

In the operation, through a small incision, the urethra will be identified and removed from the level of the prostate just below the arch of the pubic bone to the tip of the penis.

What happens immediately after the procedure?

A drainage tube will be placed in the wound to drain fluid away from the internal area where the operation has been done.

After your operation, you may return to the special recovery area of the operating theatre before returning to the ward. You will normally have a drip in your arm.

You will be encouraged to mobilise as soon as possible after the operation because this encourages the bowel to begin working. We will start you on fluids and food as soon as possible.

We normally use elastic stockings to minimise the risk of a blood clot (deep vein thrombosis) in your legs. A physiotherapist will show you some deep breathing and leg exercises and you will sit out in a chair for a short time after your operation.

The average stay in hospital will last approximately five to seven days.

Are there any side effects?

Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognized, the majority of patients do not suffer any significant problems after a urological procedure.

Please use the check boxes to tick off individual items when you are happy that they have been discussed to your satisfaction:

Common (greater than one in 10)

☐ Wound infection

☐ Pain or discomfort in the wound

☐ Failure to achieve overall cure of cancer

☐ Impotence Occasional (between one in 10 and one in 50)

☐ Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death)

☐ Blood loss requiring transfusion or repeat surgery Rare (less than one in 50)

☐ Rectal injury

Occasional (between one in 10 and one in 50)

☐ Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death)

☐ Blood loss requiring transfusion or repeat surgery

Rare (less than one in 50)

☐ Rectal injury

What to expect when you get home

When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.

You will require pain killing tablets at home for two to three weeks before you are comfortable.

You should avoid driving for at least six weeks and, in some patients, it may be even longer before they can safely drive. If your work involves physical activity, you will need at least six weeks off work. Heavy lifting should be avoided for six weeks and sexual intercourse for at least a month.

What else should I look out for?

If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your GP. Any other post operative problems should also be reported to your GP, especially if they involve chest symptoms.

Are there any other important points?

It will be at least 28 days before the pathology results on your mass become available. It is normal practice for the results of all biopsies to be discussed in detail at a multidisciplinary meeting before any further treatment decisions are made. You and your GP will be informed of the results after this decision.

Once the results have been discussed, it may be necessary for further treatment but this will be discussed with you by your consultant or specialist nurse.

Driving after surgery

It is your responsibility to ensure that you are fit to drive following your surgery.

You do not normally need to notify the DVLA unless you have a medical condition that will last for longer than three months after your surgery and may affect your ability to drive. You should, however, check with your insurance company before returning to driving. Your doctors will be happy to provide you with advice on request.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high tech equipment and / or specialist one to one care is required.

Hair removal before an operation

For most operations, you do not need to have the hair around the site of the operation removed. However, sometimes the healthcare team need to see or reach your skin and if this is necessary they will use an electric hair clipper with a single-use disposable head, on the day of the surgery.

Please do not shave the hair yourself or use a razor to remove hair, as this can increase the risk of infection. Your healthcare team will be happy to discuss this with you.

References

NICE clinical guideline No 74: Surgical site infection (October 2008); Department of Health: High Impact Intervention No 4: Care bundle to preventing surgical site infection (August 2007).

Is there any research being carried out in this field at Addenbrooke’s Hospital?

Yes. As part of your operation, various specimens of tissue will be sent to the pathology department so that we can find out details of the disease and whether it has affected other areas. This information sheet has already described to you what tissue will be removed.

We would also like your agreement to carry out research on that tissue which will be left over when the pathologist has finished making a full diagnosis. Normally, this tissue is disposed of or simply stored. What we would like to do is to store samples of the tissue, both frozen and after it has been processed. Please note that we are not asking you to provide any tissue apart from that which would normally be removed during the operation.

We are carrying out a series of research projects which involve studying the genes and proteins produced by normal and diseased tissues. The reason for doing this is to try to discover differences between diseased and normal tissue to help develop new tests or treatments that might benefit future generations. This research is being carried out here in Cambridge but we sometimes work with other universities or with industry to move our research forwards more quickly than it would if we did everything here.

The consent form you will sign from the hospital allows you to indicate whether you are prepared to provide this tissue. If you would like any further information, please ask the ward to contact your consultant.

Who can I contact for more help or information?

Oncology nurses

Uro-oncology nurse specialist: 01223 586748

Bladder cancer nurse practitioner (haematuria, chemotherapy and BCG): 01223 274608

Prostate cancer nurse practitioner: 01223 216897 or bleep 154-620

Surgical care practitioner: 01223 348590 or 256157 or bleep 154-351

Non-oncology nurses

Urology nurse practitioner (incontinence, urodynamics, catheter patients): 01223 274608 or 586748 or bleep 157-237

Urology nurse practitioner (stoma care): 01223 349800

Urology nurse practitioner (stone disease): 01223 349800 or bleep 152-879

Patient advice and liaison service (PALS)

Telephone: 01223 216756
PatientLine: *801 (from patient bedside telephones only)
Email PALS
Mail:
PALS,
Box No 53
Cambridge University Hospitals NHS Foundation Trust
Hills Road,
Cambridge,
CB2 2QQ

Chaplaincy and multi faith community

Telephone: 01223 217769
Email CUH chaplaincy
Mail:
PALS,
Box No 53
Cambridge University Hospitals NHS Foundation Trust
Hills Road,
Cambridge,
CB2 2QQ

Access office (travel, parking and security information)

Telephone: 01223 596060

What should I do with this leaflet?

Thank you for taking the trouble to read this patient information leaflet. If you wish to sign it and retain a copy for your own records, please do so below.

If you would like a copy of this leaflet to be filed in your hospital records for future reference, please let your urologist or specialist nurse know. If you do, however, decide to proceed with the scheduled procedure, you will be asked to sign a separate consent form which will be filed in your hospital notes and you will, in addition, be provided with a copy of the form if you wish.

I have read this patient information leaflet and I accept the information it provides.

Sign and date:

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