Urethral Cancer: Surgery

Surgery is the most common treatment for urethral cancer. The type of surgery done depends on where the tumor is in the urethra, whether it has spread to nearby tissues, and how big it is. The cancer as well as a rim (margin) of healthy tissue around it are removed.

Small tumors that are only in the urethra may be treated using 1 of many surgical methods. Many of these can be done through a scope put into the urethra, so your skin isn't cut. These can include:

• Laser resection. The tumor can be removed or destroyed using a laser.

• Transurethral resection. This removes the tumor with long, thin tools passed into the urethra. 

• Fulguration. This is also called electrocautery or electrocoagulation. A controlled electric current is used to burn away the cancer cells.

More extensive surgery is needed to treat tumors that are large or invade nearby tissues. This may be done through a cut (incision) in your skin.

• For people born with a penis. A part of the penis may be removed (partial penectomy). Or the whole penis may be removed (total penectomy). The bladder, prostate gland, and lymph nodes may also be removed.

• For people born with a vagina. The urethra, bladder, vagina, and nearby lymph nodes may be removed.

You may need plastic surgery to rebuild your penis or vagina if part or all is removed.

Side effects of surgery for urethral cancer

If your bladder or your urethra is removed, your surgeon will make a urostomy. This is a small opening in your belly (abdomen). It gives you a new way of passing pee out of your body. You’ll need to wear a small pouch over the hole (ostomy) in your belly to collect the pee. Another choice might be a soft tube called a catheter to drain the pee from the urostomy.

Having a urostomy can impact your comfort and sexuality. If the bladder is removed, the surgeon may make a new storage pouch to collect pee inside your body. Ask your surgeon what to expect. Also ask for advice in dealing with any changes that will be made. An enterostomal therapist will work with you on how to take care of the urostomy.

Risks of urethral cancer surgery 

All surgery has risks. The risks of urethral cancer surgery include the following:

• Too much bleeding

• Infection

• Blood clots

• Damage to your internal organs

• Bulging of organs under the incision (hernia)

• Urethral scarring. This may cause trouble peeing. If this happens, you may need a procedure called urethral dilation to reopen the urethra.

Your surgeon will talk about your risks before the surgery. Your risks depend on your overall health, what type of surgery you need, and other factors. Talk with your healthcare provider about which risks apply most to you.

Getting ready for your surgery

Your healthcare team will talk about the surgery choices that are best for you. You may want to bring a family member or close friend with you to checkups. Write down questions you want to ask about your surgery. Make sure to ask about:

• What type of surgery will be done

• What will be done during the surgery

• The risks and side effects of the surgery

• How you’ll pass pee after surgery

• Whether the surgery will affect your ability to have sex

• When you can return to your normal activities

• If the surgery will leave scars and what they’ll look like

• Whether you’ll need more treatment after surgery

Before surgery, tell your healthcare team if you’re taking any medicines. This includes over-the-counter medicines, vitamins, herbs, CBD, and other supplements. This is to make sure you’re not taking medicines that could affect the surgery. After you’ve discussed all the details with the surgeon, you’ll sign a consent form. This says that your healthcare provider can do the surgery.

You’ll also meet the anesthesiologist. You can ask questions about the anesthesia and how it will affect you. Just before your surgery, an anesthesiologist or a nurse anesthetist will give you the anesthesia medicines. This makes you fall asleep so you don’t feel pain.

After surgery

You may have to stay in the hospital for a few days. This will depend on the type of surgery you had. For the first few days after surgery, you’re likely to have pain. Your pain can be controlled with medicine. Talk with your healthcare provider about your choices for pain relief. Some people don’t want to take pain medicine. But doing so can help your healing. If you don’t control pain well, for instance, you may not want to cough or turn over often. You need to do this as you heal from surgery.

You may have a urinary catheter for a few days. This is a soft tube put through your urethra and into your bladder so that your pee goes into a bag outside your body. In some cases, you may go home with the catheter still in. If the surgery included making a urostomy, you’ll have a bag in place on your belly when you wake up. Your provider or an enterostomal therapist will teach you how to manage it.

You may have diarrhea. Talk with your healthcare provider, nurse, or a dietitian about what you can eat to reduce the chance of getting diarrhea. You may have constipation from using some pain medicine, from not moving much, or from not eating much. Talk with your healthcare team about getting more fiber or using a stool softener.

You may feel tired or weak for a while. The amount of time it takes to heal from surgery is different for each person.

Recovering at home

When you get home, you may get back to light activity. But you should not do heavy lifting and strenuous activity for at least 6 weeks. Your healthcare team will tell you what kinds of activities are safe for you while you heal.

If you have a catheter or a urostomy, your healthcare team will teach you how to manage it before you go home. If you have a urostomy, you may also be given supplies or set up to get home care visits. This is until you’re comfortable working with the urostomy on your own.

Follow-up care

You may need radiation or chemotherapy after surgery to kill any cancer cells that may be left. This is done to help reduce the chance that the cancer will come back. Your healthcare provider will talk with you about these types of treatments and what you'll need to do next. You’ll also see your surgeon again.

When to call your healthcare provider

Let your healthcare provider know right away if you have any of these problems after surgery:

• Bleeding

• Redness, swelling, or fluid leaking from your incision

• Fever

• Chills

• Pain that gets worse

• Problems with the catheter or urostomy

Make sure you know how to get help any time, even at night and on weekends or holidays.