POST-OPERATIVE CARE FOLLOWING BUCCAL MUCOSAL GRAFT URETHROPLASTY
What kind of anesthesia is used for this surgery?
How many hours does the surgery take?
About 2-5 hours depending on the length of stricture.
What is the role of smoking?
In patients who smoke, there will be a condition in the oral mucosa called submucosal fibrosis. Post-operatively these patients may have more pain at oral site compared to the non-smokers. So we advise all patients to stop smoking 4 weeks prior to the operation. Those with submucosal fibrosis will also have poorer results of urethroplasty, and a higher risk of oral cancer.
What care has to be taken for the operated area inside the cheek?
After the operation, you will be advised to open the mouth widely as often as possible, to blow a balloon often and also to do salt water gargling, especially after taking fluids or food. This is because food can get stuck to the raw area in the mouth and by gargling it will get cleared.
When can I eat normal food?
Usually, for about 6 hours after the operation, you will be kept nil by mouth, and then you can start taking oral liquids. Soft diet can be started from the 1st post-op day itself. However, some patients may take more time to start a soft diet, because of pain.
When will the buccal wound heal?
A new layer of mucosa will grow over the raw area and it will usually complete in about 3 weeks.
What are the immediate problems that may occur in the oral cavity?
Bleeding: When you spit after gargling salt water, you may find a tinge of blood in it. This usually stops after a couple of hours. If bleeding is from small vessels your doctor may advise you to keep an adrenaline-soaked gauze piece at the site of bleeding which will stop the bleeding. Rarely if bleeding continues, you may be taken to the operation theater to stop the bleeder.
Pain: at the operated site can be managed by oral tablets or local solutions.
Swelling: There will be some swelling in the cheek which will usually settle in a couple of days.
Parotitis: Less than 0.2% of patients can have painful swelling of the parotid salivary gland. This gland is located in front of and below the ear. This occurs in patients who have a bad oral hygiene in the post-op period or if there accidental injury to the duct opening in the mouth. This can be managed with pain medications, antibiotics and good oral hygiene.
Can I wear dentures and when?
Dentures can be worn as early as 3 weeks after the procedure and usually, it should not cause any problem. If there is any sharp area over the denture which is causing recurrent injury and bleeding, then you need to show it your dentist to make appropriate changes in the dentures.
Are there any delayed problems than can occur in the oral cavity?
At the site of the removal of the buccal mucosa, a fibrous band can develop in about 2% of patients. You may then not be able to open the mouth as fully as before. For this reason, you are advised to do wide mouth opening exercises regularly in the initial period.
What are the precautions to be taken at the perineal site?
The catheter care will be explained by the nurse at the time of discharge. The perineal wound has to be cleaned with soap and water especially after passing stools. You may have some scrotal swelling, we advice scrotal support to reduce it.
Are there any risks concerning erection, fertility and urinary incontinence after the surgery?
No, except when the urinary sphincter is already damaged or involved in scar.
How many days of hospital stay is expected following the surgery?
In general, by 2-3 days you would be discharged.
How long will I have to be on catheter after the surgery? Is it painful to be on catheter?
The catheter will be left in for three weeks after the surgery. The catheter is well tolerated because of its smaller size. If you have any frequent pain discuss with your doctor, who will prescribe you medications. Avoid constipation during this period. You will be instructed to walk with the urine bag tied around the waist.
When will I be able to resume my work, sexual and sports activities?
You can resume your regular work 1 month after surgery. But if your job involves sitting for long hours, take short frequent walks of 10-15 minutes every couple of hours. Sports & Sexual activity can be gradually resumed about 2-3 months after the removal of the catheter.
Can I ride a bike or a motorcycle or travel immediately after the surgery?
It is recommended not to ride bikes, motorcycles or travel for 3-4 weeks after the surgery.