Urethral injury to recovery: every strange experience, explained

The doctor asked me to try to urinate before the SPC insertion, but I couldn't.

• This is to see if any urine is able to go through. If not, it confirms the urethra is ruptured.
• Pushing harder does not help, and can force urine out through the injury into the surrounding tissue.
• A few drops of blood, or a small dribble, may come out without any real stream. That still counts as not passing urine.

The doctor tried inserting a catheter via my penis but was unable to. Why?

• A normal catheter has to travel the full length of the urethra. If that channel is torn or completely narrowed, there is nothing for the tube to follow.
• Trying a size or two and then stopping is good practice, not failure. Repeated attempts can do real damage.
• If it does go through, the urethra still has some shape, and your doctor will decide the course of action accordingly.
• If it will not pass, the alternative is a suprapubic catheter (SPC), which enters the bladder through the lower abdominal wall and bypasses the urethra completely.

What actually happens during the suprapubic catheter insertion procedure?

• It is commonly done in an operating theatre under sterile conditions, particularly after trauma.
• You are given anaesthesia, so the procedure itself is not painful. This may be local with sedation, a spinal, or a general anaesthetic. Ask beforehand which one you are having.
• Your bladder needs to be full so it sits high and clear of the bowel. Its position is confirmed with ultrasound, and sometimes a camera, before anything is inserted.
• The skin above the pubic bone is cleaned and draped, a small cut is made, and the tube is passed into the bladder. A balloon at the tip is inflated to hold it in place, and it is stitched or taped to the skin.
• The insertion itself is quick, but with anaesthesia, positioning, imaging and recovery, expect to be away from the ward for a couple of hours. After trauma it often takes longer, since the team may look further before finishing.
• You wake up with the tube already draining into a bag.
• Afterwards: soreness once the anaesthetic wears off, a dressing, blood-tinged urine at first, and often a deep cramping urge to urinate as your bladder objects to the balloon.

Blood is coming out of my penis in gushes every few hours. Is this normal?

• It usually comes in waves or spurts over 48–72 hours rather than a steady drip, and it may even come in heavy doses.
• Dark, clotted blood is the better sign. Flowing, bright red blood should be reported to your doctor.
• Your team will be tracking how much. Inform them if it increases rather than settling.

I can feel something moving inside my penis in spurts.

• You are feeling blood and small clots travelling along the urethra.
• People describe it as crawling, pulsing, or something shifting inside. It is not tissue moving.

My scrotum and the area between my legs are bruised and swollen.

• Bruising often spreads into a butterfly-shaped patch across the perineum and scrotum, sometimes onto the lower abdomen.
• To control bleeding and swelling, the team may strap a perineal compression bandage in an X shape across the site of the trauma. It is uncomfortable and awkward to sit with, but it is doing real work.
• Colour changes over 2–3 weeks: red, purple, green, yellow. That sequence means it is clearing.
• Contact your doctor immediately if swelling increases rapidly, if the skin darkens or breaks down, or if there is fever with severe pain.

I keep getting erections, and each one seems to restart the bleeding.

• Erections in these early days often do restart or increase bleeding.
• You cannot prevent them — most happen during sleep, entirely outside your control.
• If night-time erections are causing repeated bleeding or a lot of pain, ask your doctor if any medicine should be taken for the same.

What other potential issues should I check for?

• On the first day, doctors are actively checking for a pelvic fracture, injury to the bladder or rectum, urine leaking into surrounding tissue, and significant blood loss.
• An orthopaedic review, blood tests and imaging are routine for exactly this reason.
• If those came back clear, it genuinely simplifies everything that follows.

Why do I have to wait months for surgery? Can't they just fix it now?

• Operating into swollen, inflamed tissue gives the surgeon a blurred picture of what is actually damaged.
• Waiting lets the narrowing settle into a mature, defined scar that can be measured, removed cleanly, and joined.
• Around three months is a commonly used interval before a planned urethroplasty, though your surgeon may choose differently for your situation.

How should I tape the SPC, and where does it sit relative to my underwear?

• Leave a gentle loop of slack where the tube leaves your abdomen, so movement never pulls on the internal balloon.
• Let the tube run downward towards your thigh, and anchor it in 2–3 places so the weight of the bag never hangs on the incision point.
• Use a butterfly tape: the tape should wrap around the tube and only then stick to the skin, so the tube itself never rests against you and can still shift a little.
• To do it yourself: (1) lay a strip of tape over the top of the tube without touching the skin, (2) bring one side down alongside the tube, leaving a small buffer before the skin, (3) wrap the tape around the other side of the tube, (4) press that end onto the skin.
• Wear the waistband above the incision point. Keep the tube within the underwear and out of the leg-hole, rather than letting the waistband run over the tube — avoid the tube coming out over the top of the waistband. Make sure the waistband does not press on the incision point. If that is difficult, wear underwear whose waistband sits comfortably below the incision point, or one with a soft waistband if it has to sit on top of the tube.
• If that is difficult, wear underwear whose waistband sits comfortably below the incision point, or if the waistband has to sit on top of the tube, choose one with a soft waistband.
• Avoid tight bends, which restrict flow and build pressure whenever the bladder contracts.
• For the first few days, when the area is most painful, it helps enormously to have someone else do the taping. Within a week most people manage alone.

Is it all right to not wear underwear at all?

• A tight V-cut brief is worth wearing throughout this phase, even at home.
• It holds the scrotum up against the body, which relieves heaviness and dragging.
• It also steadies the tube, so the catheter is not swinging and tugging at the incision point every time you move.
• Wear the waistband above the incision point. Keep the tube within the underwear and out of the leg-hole, rather than letting the waistband run over the tube — avoid the tube coming out over the top of the waistband. Make sure the waistband does not press on the incision point. If that is difficult, wear underwear whose waistband sits comfortably below the incision point, or one with a soft waistband if it has to sit on top of the tube.

My catheter is very stiff, and I have been told it will be swapped for a softer one after a few weeks.

• Many doctors place a firmer catheter at the start, then change to a softer, more flexible one once the tract has settled.
• The firm tube is harder to live with: it does not bend easily, it pulls at the incision point, and it can ache there whenever you move.
• Because it will not curve, taping it is awkward. Work with the direction it naturally points rather than forcing it into a bend.
• Tape it in two places — one close to the site with a gentle loop of slack vertically, one further down — so its stiffness is absorbed by the tape rather than by your skin.
• Do not tape it into a tight curve. A kinked stiff tube restricts flow and pushes back against the incision point.
• Expect this to get noticeably easier once the softer catheter goes in.
• Underwear matters here. Choose a pair whose waistband sits below the incision point, or one with a very soft waistband if it has to sit above — a firm elastic band will push against a stiff catheter all day.

A stiff catheter holds its own curve instead of following your body, making it tug at the incision point.

Should I switch between the small day bag and the bigger night bag?

• One option is a leg bag strapped to the thigh during the day and the larger bag at night on a stand beside the bed. This makes you feel far more normal and mobile during the day, and is what many people prefer.
• The other option is to keep the large bag throughout — fewer changes, but you have to carry it in your hand.
• Whichever you choose, always keep the bag below bladder level so urine cannot flow back.

How do I take a bath or shower with the catheter in?

• Early on everything feels delicate and bathing does hurt. Go slowly and stop when it stings; it eases within a couple of weeks.
• Go in with the tapes on. There is no need to remove them.
• Sit on a stool. It removes the balance problem completely and is far less tiring.
• Keep everything within arm's reach before you start, so you are never twisting or reaching mid-shower.
• If a tape comes off while you are in there, simply hold the catheter with one hand and finish. Nothing bad happens in those few minutes.
• You can shower with the bag attached. Another option, if you are changing from the night to the day urobag at that time anyway, is to remove the night bag, clamp the catheter, shower, and attach the day bag afterwards. Then you do not have to manage the urobag in the shower at all. But only clamp if your team has said clamping is fine for you.
• Use a mild soap — a baby soap or another gentle, unperfumed one — around the catheter site and the tip of the penis. Harsh or strongly perfumed soap stings and dries the skin at both places.
• Let plain water run over the site rather than scrubbing it, and rinse all the soap off.
• Avoid soaking baths, pools and the sea until your team clears you.

How do I clean around the SPC incision point after a bath?

• Expect to find some discharge or pus around the tube every single day, for as long as the catheter is in place. Cleaning it away is routine maintenance, not a sign of infection.
• Use soft tissue or clean gauze. Pat, don't scrub.
• Clean around the site from all four sides of the tube — crust collects unevenly and it is easy to miss one side.
• Wipe away any discharge or crust that comes off easily. Anything stuck firmly should be left alone rather than pulled.
• Do not rub hard. Rubbing irritates the skin and makes the over-healing tissue bleed.
• Let it dry properly before you retape.

How do I change the urobag without contaminating everything?

• Sanitise your hands first — the alcohol also makes the tape much easier to peel off, so do this before removing any tape.
• Sanitise the connector tip of the new bag before you bring it anywhere near the catheter.
• Hold a small tissue at the catheter tip while you disconnect, so any drops of urine land in the tissue rather than on you or the floor.
• Swap the bags quickly and reconnect firmly.
• Seal the used bag inside a zip-lock or kitchen bag before disposing of it. If you swap bags morning and night, you will use two sealed bags a day.
• Retape with the same gentle loop of slack you started with.

Do I need to keep replacing the urobag itself?

• Your team will typically change the catheter itself every few weeks, and will usually give you a new bag at the same time.
• In between, there is generally no need to replace it unless it starts smelling strongly or looks visibly dirty.
• Follow whatever schedule your own team gives you — practice varies between hospitals.

What actually happens during the routine catheter change?

• Most teams change a suprapubic catheter every three to six weeks, in a clinic room rather than an operating theatre.
• The site is cleaned, the retention balloon is deflated with a syringe, and the old tube is slid out. That takes seconds.
• The new tube is passed straight down the same tract and the balloon is re-inflated. Expect a brief deep cramp or an urge to urinate at that moment.
• The whole visit is usually 10–15 minutes, with no anaesthetic beyond a lubricating gel.
• Blood-tinged urine, mild soreness at the incision point, and a few stronger spasms for a day afterwards are all normal.
• A softer catheter is often used from this point onward, which most people find noticeably more comfortable.

Can I work, travel and go out with this?

• Desk work and short travel are usually fine — work from home if you can, at least early on. Carry spare bags, dressings and your hospital numbers. A leg bag under loose trousers is invisible to others.
• Heavy lifting, straining, cycling and contact sport are the things to avoid until your surgeon clears you.

I was told the bleeding would stop in 4–5 days, but I had spotting from the penis for three weeks.

Common — the quoted timeline is an average, not a rule

• Occasional pink or brown staining on underwear for two to four weeks is frequently reported.
• What matters is the trend: spotting should become smaller, less frequent and darker over time.
• Fresh bright-red bleeding that returns to day-one volumes does need to be reported.
• Taping a small folded gauze over the tip of the penis applies gentle pressure, which slows the oozing and saves your underwear. Change it whenever it is soiled.

Small amounts of urine or a brownish discharge keep coming out of my penis.

• The urethra is still connected and still producing secretions — it has not switched off just because urine is going elsewhere.
• Discharge is often whitish, yellowish or rusty brown. A folded tissue or a small pad handles it.

There is some blood at the SPC incision point.

A few spots is fine. Steady flowing blood is not

• Spots or streaks on the dressing, especially after a tug, a bath, or a catheter change — common and not concerning.
• Blood that keeps flowing, soaks the dressing repeatedly, or comes with a swelling under the skin — contact your doctor.
• Show the site to your doctor at your next visit. If the skin around it looks irritated or infected they may prescribe an ointment.

There is blood in the catheter tube or in the bag.

• A pink or light red tinge, or occasional darker wisps, is common — particularly after a catheter change, after exertion, or after straining.
• It usually clears over a day or two, especially if you drink plenty of water.
• Contact your doctor for thick red urine, visible clots, or blood that is blocking the flow.

Such red blood particles, or pink to light red blood in the tube, is normal.

There is a small amount of pus around the SPC incision point.

• A little yellowish or creamy discharge and crust around the tube is an everyday finding with a long-term catheter.
• It will be there every day for as long as the catheters are in, and it comes back within hours of cleaning. That is the normal state of a tube passing through skin.
• Clean it gently and let the area dry. It reappears; that is not a sign you cleaned badly.
• Report it if it becomes heavier, foul-smelling, or comes with spreading redness, increasing pain or fever — that pattern suggests infection rather than routine discharge.
• Show the site to your doctor at each visit. If it looks infected they may prescribe an ointment, which usually clears it quickly.

There are cloudy, stringy or flaky substances floating in my urine.

Normal

• Most of what you are seeing is material clinging to the inside of the plastic tube and the bag, not something wrong with your urine.
• It looks like white or pale strands, flakes or a cloudy film, and it builds up over the day.
• On its own, with no fever and no pain, it needs no action.
• Drinking enough water through the day keeps it much lighter.

I have a urinary tract infection. Should I be worried?

• Almost everyone with a catheter in place for weeks or months will grow bacteria in their urine. A positive test on its own does not automatically mean you are ill.
• The findings that matter are fever, chills, back or side pain, feeling generally unwell, new pain, or a sudden worsening of spasms.
• Any fever means contacting your doctor the same day — do not wait it out at home. With chills, shivering or back pain, go to Emergency. Let your doctor decide on treatment; do not start or stop antibiotics on your own.

I get a sudden urge to pass urine even though the SPC is draining everything.

• The urge can be intense, sometimes with a cramp low in the abdomen or a sensation at the tip of the penis.
• A few drops may leak out of the penis or around the tube when it happens.
• Many people also describe a vague, hard-to-name feeling of fluid shifting or moving around inside, almost like something is out of balance in the lower abdomen. That is normal too.
• If spasms are frequent or disturbing your sleep, ask your doctor whether a bladder relaxant medicine would help, or whether the one you are on could be adjusted. This is a common and very solvable problem, and it is easy for it to be overlooked when everyone is focused on the repair itself.

I get a burning feeling at the tip of my penis and a strong urge to urinate. Should I try?

• As long as urine is collecting in your bag, your bladder is emptying properly and nothing is being retained. The urge is a false signal.
• Trying to void against a narrowed or repaired urethra achieves nothing and adds strain.
• The burning at the tip is a signal coming from your bladder, not damage to the tip itself.
• If it is frequent enough to interfere with your day or your sleep, ask your doctor whether a stronger bladder relaxant medicine is appropriate for you.

Should I be on a bladder relaxant medicine while the SPC is in?

• The catheter balloon irritates the bladder continuously, so spasms are expected for as long as it is in place.
• Bladder relaxants are commonly used in exactly this situation, and the strength can usually be adjusted if symptoms are severe.
• It is worth raising proactively — it is easy for this to be overlooked when everyone is focused on the repair itself.
• Never start, stop, double or change a dose on your own. If symptoms return after stopping, tell your doctor rather than restarting it yourself.

I can't sleep because of these sensations.

• Experiment with position. Small changes often make a large difference — try lying on the opposite side, adding a pillow under the knees, or being slightly propped up.
• Make sure the tube has slack and is not being pulled by the bag or the bedsheet. Traction at night is a frequent hidden cause.
• Keep the night bag on a stand below bladder level, with enough tubing that turning over does not tug.
• If sensations are still keeping you awake night after night, tell your doctor. Ask specifically whether the bladder relaxant medicine should be adjusted — poor sleep is a legitimate reason to change it, not a complaint to tolerate.

Do I have to sleep flat on my back, or can I turn over?

• Move the tubing with you before you turn, so you do not roll onto it or pull it.
• Avoid sleeping fully on your front — it presses directly on the site. A pillow between the knees helps on your side.
• You can lie on your back or either side; most people prefer one side. Early on, move slowly and push up with your arms rather than your stomach. It becomes unremarkable within a couple of weeks.
• If your team has given you specific instructions after a procedure, those override this.

My scrotum feels heavy, hangs low, and has a dragging ache.

• Snug, supportive underwear — a tight V-cut brief that holds everything close to the body — usually relieves this within a few days, and is one of the most useful things you can do.
• Lying down with a rolled towel supporting the scrotum also helps.
• If the heaviness persists after the swelling has settled, your doctor may suggest a scrotal ultrasound to look for a varicocele or another cause. That is a routine check, not a sign that something is wrong.

My scrotum still hangs low, though the pain and heaviness have gone.

• The absence of pain and heaviness is the meaningful part — it tells you the swelling has resolved.
• Position alone, with no discomfort, has no medical significance.
• A snug V-cut brief holds things comfortably in place while tone returns.
• If heaviness or a dragging ache comes back without swelling, your doctor may suggest a scrotal ultrasound to check for a varicocele — a simple, painless scan.

I get erections, but my foreskin never pulls back fully like it used to.

• Residual swelling in the penile and perineal tissues limits both full rigidity and foreskin retraction.
• It usually returns as the tissues soften over the following months.
• Important: if you retract the foreskin and it becomes stuck behind the head, swollen and painful, go to emergency the same hour.

An erection sometimes felt close to ejaculation, but nothing came out.

• The sensation of climax and the physical expulsion of semen are two separate mechanisms. They can come apart.
• Semen may not appear, may appear later, or may be brown-stained with old blood. All are reported, and none means permanent damage.

I have not had any erections since the accident.

• Erections often disappear for weeks or months after a pelvic injury and its treatment. In most people they return.
• Pain, anxiety, poor sleep and having a tube in place all suppress them, quite apart from any physical damage.
• You may be having them at night without knowing. Waking with one, even occasionally, is a strong sign the machinery is intact.
• Mention it before your surgery. Many teams do a penile Doppler scan beforehand, which records how well the arteries are working and gives everyone a baseline to compare against later.
• This is a normal thing to ask about, and urologists expect the question. Raising it early is better than waiting in silence.

The tube pulls and stings when I bend, sit or turn.

• Go back to the taping basics: a loop of slack at the site, downward routing, and 2–3 anchor points down to the thigh.
• Check the tube is not caught under a waistband or a seatbelt.
• Sitting slightly reclined rather than bolt upright reduces pressure through the pelvic floor.
• If a stiff catheter was placed for the first few weeks rather than a flexible one, expect more pulling and stinging than you otherwise would. It improves noticeably once it is swapped for the softer tube.

Urine is leaking around the tube, and my dressing keeps getting wet.

• Occasional leaking during a spasm or a cough is normal.
• Constant leaking usually means the catheter is partially blocked, so urine is taking the easier route around it.
• Check first: kinked tubing, bag above bladder level, full bag, clothing pressing on the tube.

There is a red, fleshy, easily-bleeding bump at the SPC incision point.

• This is extra healing tissue that builds up around the tube — the body doing too much repairing rather than too little.
• It bleeds easily when rubbed and can be tender. It is a healing response, not an infection.
• Reducing tube movement is the main fix.
• Show it to your doctor at the next visit. If it looks infected they may prescribe an ointment or a simple treatment for it, which usually settles it quickly.

Granulation tissue: a raised, glossy red rim of over-healing skin hugging the tube. It bleeds easily but is a healing response, not an infection.

The catheter has suddenly stopped draining.

• Check for kinks, a full bag, or the bag sitting above bladder level. If nothing drains and your lower abdomen feels full, hard or painful, contact your team or go to hospital.
• Do not try to flush or reposition the tube yourself unless you have been specifically taught how.

What happens if the catheter gets pulled out?

• Do not try to push it back in yourself. A tube reinserted blindly can end up outside the bladder.
• Cover the site with a clean dressing or pad and go in. Take the catheter with you if you still have it, so they know the size.
• Time matters here more than most things in this handbook: the tract can begin narrowing within hours, and once it closes, replacing it becomes a much bigger procedure.
• Prevention is mostly about slack and anchoring — 2–3 taping points, and care when standing up, dressing, and turning in bed.

I'm constipated, and I'm afraid of straining.

• Reduced movement, painkillers and drinking less all push you towards constipation.
• Ask your doctor about it early rather than waiting for it to become a crisis — it is a routine thing for them to manage.
• Fluids, fibre and short walks do most of the work.

What actually happens during the RGU / MCU test?

• You lie on an X-ray table. A dye that shows up on X-ray is put into the urethra through the tip of the penis, and also into the bladder through the SPC.
• You are then asked to pass urine while the X-ray runs, so they can watch the dye move.
• If you cannot pass anything, that is the result, not a failure. It tells the surgeon the narrowing is complete.
• Expect a full, urgent, slightly panicky feeling and a sense of pushing against a wall. It passes as soon as they drain you.
• Some dye or a little blood may come out for a day afterwards. That is expected.

What actually happens during the penile Doppler test?

• A small injection into the side of the shaft triggers an erection, and ultrasound then measures blood flow in and out.
• Most people report a brief sting, then warmth and a dull ache — usually considerably less unpleasant than the warning beforehand suggests.
• The erection can last 30–60 minutes afterwards. If it lasts more than 4 hours and is painful, go to emergency.

What actually happens during the urethroplasty surgery?

• Nil by mouth from the night before, and the area is shaved and cleaned in the morning.
• Spinal anaesthesia is common for this operation — an injection in the back numbs you from the waist down, usually with sedation so you doze through it. Recovery afterwards is quicker and there is less nausea than with general anaesthesia.
• You are positioned with your legs raised and apart, so the surgeon can reach the perineum. This is done after you are numb.
• The operation itself commonly takes two to four hours depending on the length of the narrowing.
• You wake up with two catheters, a dressing between your legs, and often a small drain. Your legs feel heavy and useless for a few hours until the spinal wears off — expected, and it passes completely.
• Most people are moved back to the ward the same day, and stay two to four days.

What they do inside

• A vertical cut is made in the perineum — the area between the scrotum and the anus. Depending on where the narrowing sits, it may extend a little way onto the lower part of the scrotum.
• Muscle layers are separated, not cut through, to reach the urethra underneath.
• The scarred segment is removed completely. That is the key step.
• The two healthy ends are opened out lengthways and stitched directly to each other over a catheter (an anastomotic repair). If the narrowing is long, a graft — often taken from the inside of the cheek — may be used to widen the channel instead.
• The muscle is closed back over the repair, a small drain is left for a day or two, and a compression dressing goes on.

Why is the cut in such an awkward place?

• The bulbar urethra sits deep in the perineum, and that is the only direct route to it.
• If the narrowing extends further forward, the cut may run up onto the lower scrotum as well. That is planned, not a complication.
• The incision follows the natural midline seam, which heals into a discreet line.
• It does mean sitting is uncomfortable for the first couple of weeks. A cushion with a cut-out helps a great deal.

Why do I have two catheters after the operation?

• The penile catheter sits across the new join, holding the two ends lined up while they knit together. It is acting as a splint, not as a drain.
• The SPC does the actual work of emptying your bladder, so urine stays away from the fresh repair.
• Both are temporary. The penile one usually comes out first, after a few weeks.

How do I tape both catheters, and how do they sit with my underwear?

• Tape each catheter on its own side so they do not cross, rub against each other, or pull one another when you move.
• Anchor each tube in 2–3 places on its way down to the bag, so the weight of a filling bag is carried by the tape on your thigh and never hangs from the incision point or the tip of the penis.
• In the first days after surgery, ask someone to help with the taping. Bending and reaching is exactly what hurts most, and a second pair of hands makes it far easier. You will be doing it yourself within a week or two.
• Leave a loop of slack at both exit points — the abdomen for the SPC, and the tip of the penis for the penile catheter.
• The penile catheter should rest without tension. Do not let its weight hang from the tip; anchor it to the upper thigh or lower abdomen so the tip is never being dragged sideways.
• The SPC runs downward as before, on the opposite side, to its own bag.
• Wear the waistband above the incision point. Keep the tube within the underwear and out of the leg-hole, rather than letting the waistband run over the tube — avoid the tube coming out over the top of the waistband. Make sure the waistband does not press on the incision point. If that is difficult, wear underwear whose waistband sits comfortably below the incision point, or one with a soft waistband if it has to sit on top of the tube.
• If that is difficult, wear underwear whose waistband sits comfortably below the incision point, or if the waistband has to sit on top of the tube, choose one with a soft waistband.
• Check the taping every time you get up. Most of the sharp, sudden sensations in this phase come from a tube that has quietly moved.

How do I bathe with two catheters?

• The first few times everything feels fragile and it does hurt. Go slowly, keep it short, and build up.
• Go in with the tapes on, and sit on a stool.
• You can go in with the bags attached — with two tubes, unclipping things adds risk rather than convenience.
• If a tape comes off, hold that catheter with one hand and finish calmly.
• Use a mild soap — baby soap or another gentle, unperfumed one — around the SPC site and the tip of the penis, and rinse it off completely.
• Keep the stitch line out of direct spray if your team has said to, and pat everything dry afterwards rather than rubbing.

How do I clean around the penile catheter after a bath?

• There will be some discharge or crust every day while the catheters are in. Finding it is expected, not a warning sign.
• Hold the catheter steady with one hand so it is not being pulled while you clean.
• If you have a foreskin, ease it back only as far as it moves comfortably, clean, and always bring it forward again afterwards.
• Wipe from the tip of the penis outward, away from the opening — never back towards it.
• Use a mild or baby soap on the skin, then rinse fully. Crust collects where the tube meets the opening, so clean all the way around the tube.
• Pat dry with a soft tissue. Leaving the area damp is what causes most of the soreness at the tip.
• Do not push anything into the opening, and do not pull off crust that is stuck firmly.

Should I keep switching between the day leg bag and the night bag in this phase?

• With two catheters, swapping bags means four changes a day instead of two, which is a lot of work when you are mostly resting anyway.
• A simpler approach: keep the larger bags on at home, and switch to leg bags only on the occasions when you have to step out.
• If you are up and about more, the leg bags may be worth the extra effort. Either is fine.

My stitches hurt a lot when I move, walk or sit.

• Pain on movement is expected while the stitches are fresh. It should reduce week by week, not increase.
• Bathe every day. Dried blood and crust collect along the stitch line, and once that hardens it pulls on the skin with every step — a lot of the sharp movement pain comes from this rather than from the repair itself.
• Clean gently with a mild or baby soap, rinse fully, and pat dry. Do not scrub or pick at anything stuck firmly.
• Sit slightly reclined with your weight on your thighs, or use a cushion with a cut-out.
• Tell your doctor if pain is increasing after the first few days, or comes with redness, heat or fever.

Sitting is painful. Am I damaging the repair by sitting on it?

• The repair is deep and protected by muscle. Ordinary sitting does not undo it.
• Use a cushion with a cut-out, or sit slightly reclined with your weight on your thighs rather than the perineum.
• Avoid long car journeys, hard chairs, and anything resembling a bicycle saddle.

Which body positions are comfortable while the stitches heal?

• A pillow between the knees when lying on your side is the single best trick. It stops the thighs pressing together, so the stitches stay open to the air and stay dry.
• On your back with knees slightly bent over a pillow takes tension off the perineum. Lying completely flat with legs straight pulls on the stitch line.
• One leg drawn forward while on your side works well for some people and not others. Go by comfort — there is no correct version.
• Avoid lying face down. It presses directly on the repair and on the SPC site.
• Sitting: recline slightly with your weight on the thighs, or use a cushion with a cut-out. Avoid hard chairs and long car journeys.
• Getting up: roll onto your side and push up with your arms rather than sitting straight up using your stomach.

My scrotum and penis are swollen and bruised again after surgery.

• Usually peaks in the first week, then settles over two to three weeks.
• A snug V-cut brief, elevation when lying down, and avoiding long periods standing all help.
• Contact your doctor immediately if the swelling increases rapidly, becomes hard and hot, if the skin darkens or starts breaking down, or if it comes with fever.

There is blood in the penile catheter or the SPC.

• Pink or light red urine in the first days after the operation is expected and usually clears steadily.
• It can flare briefly after moving, an erection, straining or a bump to the tube, then settle again.
• Contact your team for thick red urine, visible clots, blood that keeps getting darker or heavier, or any blood that blocks the flow.
• Drinking enough water genuinely helps clear it.

Brownish-red or whitish fluid keeps leaking from around the penile catheter.

• This is fluid draining out around the outside of the catheter. It looks alarming on underwear and means very little.
• Colour ranges from rusty brown to pale yellow to whitish.
• Keep a folded tissue or pad there and change it often. Report it only if it becomes thick pus with pain or fever.

The tip of my penis is sore and irritated all the time.

• Extremely common with a catheter in place, and it settles quickly once the tube comes out.
• Rinse gently with water and pat dry. Check that the catheter is not pulling — that is the fixable part.
• Report it if the head becomes red, swollen and genuinely painful.

I get sudden bladder cramps even with two tubes draining.

• There are now two balloons and a catheter shaft inside — more for the bladder to object to.
• If cramps are frequent or severe, ask your doctor whether a bladder relaxant medicine would help or whether yours needs adjusting.
• Report cramps that come with leaking around the tubes, or with fever.

My stitches itch, feel tight, and the area around them is numb.

• Itching means the wound is knitting. Tightness means scar is forming, and it softens over months.
• Numbness or altered sensation around the scar and scrotum is common and usually improves gradually.
• Keep the area clean and dry, and do not apply anything that has not been prescribed.

I keep getting erections with the catheter in. Am I damaging the repair?

• Erections are expected and unavoidable, especially at night. Surgeons plan for them.
• An erection can genuinely hurt while a catheter is in, because the penis lengthens along a tube that does not stretch with it.
• Leave a small loop of slack just beyond the tip of the penis before you tape the tube down, so there is room for the penis to extend without dragging on the catheter.
• A pulling sensation, a little spotting at the tip, or a brief ache at the stitches is common. None of it means the join has failed.
• The foreskin may not retract fully during this period. Normal, and temporary.
• If night erections are frequent, painful or causing repeated bleeding, ask your doctor whether anything can be done to reduce them during the healing period.

Should I keep taking the antibiotics I was given?

• With a catheter still in place and a fresh repair, many teams keep patients on antibiotic cover for a defined period.
• Finish exactly the course you were prescribed, and ask before your supply runs out whether it should continue.
• Do not stop early because you feel fine, and do not extend it on your own.
• Any fever or chills means contacting your doctor the same day — do not wait it out. It changes the plan and usually needs a urine test.

Is being mostly in bed for weeks bad for me?

• Rest protects the repair, but total immobility carries its own risks: blood clots in the legs, chest infection, stiffness, constipation and low mood.
• Ask your team exactly what movement is allowed for you — it is usually more than you assume.
• Seek urgent help for a swollen, painful calf, or sudden breathlessness or chest pain.

What happens to the stitches, and how do I know they are healing properly?

• The stitches used here are dissolvable. You do not need to go back to have them taken out.
• Early on they stick out and feel like small bristles or knots. That is expected and does not mean anything is loose.
• Over roughly two to four weeks the dark ends soften, break off and come away — often on a towel or in the bath. Do not pull at anything still attached.
• Underneath, new pink or pale skin appears along the line. Pink is a healing colour, not an infected one.
• The line will feel firm and raised for a while before it flattens and fades over months.
• Healing well looks like: less pain each day, itching, dry flaking, dark stitch ends dropping off, a thin pink line forming.

How do I know if my stitches are infected?

• Concerning together: spreading redness, pain that increases after the first few days, heat, swelling, pus or a bad smell, the stitch line separating, fever.
• Reassuring: mild redness along the line itself, clear or slightly blood-stained ooze in the first days, itching, and pain that lessens each day.
• Urine leaking from the stitches is not normal — report it the same day.

What if a catheter accidentally comes out?

• Do not try to reinsert it yourself. Contact your urology team immediately or go to hospital.
• A displaced penile catheter in this window can compromise the fresh repair.
• A displaced SPC matters because the tract can start narrowing within a few hours.
• Prevention: 2–3 taping points per tube, generous slack, and care with clothing, bedsheets and standing up.

What actually happens during the penile catheter removal procedure?

• The retention balloon is deflated with a syringe, and the tube is slid out. It takes seconds.
• Expect a strange pulling sensation and a brief sting, sometimes a moment of stinging as the tip passes the opening.
• A little blood or discharge at the tip afterwards is common.
• You will usually be asked to drink and then try to pass urine, so your team can see the first stream themselves.
• Some units check the repair with imaging before removal. If yours does, that is routine.
• The SPC stays. That is deliberate, and it is your safety net.

Why is the SPC still in if I can pass urine now?

• This period is a trial of void. The SPC stays until your team is confident you are emptying well.
• If the new channel swells and blocks, you already have a working outlet — no emergency, and no need to re-catheterise a fresh repair.
• Your team may also use it to measure how much urine is left behind after you void.

The first few times I passed urine, it burned intensely.

• It usually improves noticeably over the first several days.
• Drinking steadily through the day dilutes the urine and reduces the sting.
• Burning that persists or worsens, especially with fever, points to infection rather than healing — report it.

I feel the urge to urinate every 15 to 60 minutes, and only a small trickle comes out.

• The urge is real, but it is being triggered by irritation rather than by a genuinely full bladder.
• It settles quickly once the SPC comes out and the inflammation subsides.
• If it is relentless and exhausting, ask your doctor whether you should unclamp the SPC so urine drains freely into the bag for a while. That takes the pressure off the bladder and often breaks the cycle — but it is their call, since it interrupts the trial of void.
• If this comes with fever, get a urine test — infection amplifies it dramatically.

My stream stops by itself before I finish, and I never feel completely empty.

• You are not doing this consciously, and you cannot override it by pushing.
• Do not strain. Straining worsens pelvic floor guarding and makes the next attempt harder.
• Try the double void: finish, stand and relax for 30–60 seconds, breathe out slowly, then try again gently.
• Some of the "not empty" feeling is real residual urine and some is irritation mimicking fullness. Your team can measure it properly — that number is the real answer, not the sensation.

Right at the end I feel the SPC being sucked inward, and then it burns sharply.

• A very commonly described sensation, and one that disappears completely when the SPC is removed.
• Making sure the tube has slack and is not taped under tension reduces it noticeably.

A few drops of urine leak into my underwear after I have finished.

• A small amount of urine left behind after the stream stops is called after-dribble. It is a nuisance rather than a problem.
• Stay on the toilet for a few extra seconds rather than standing up as soon as the stream stops.
• Breathe out slowly and let your pelvic muscles relax instead of squeezing. Tensing traps the last drops rather than clearing them.
• Sitting down to urinate often helps in the early weeks, as it relaxes the pelvic floor more completely.
• A folded tissue or a small pad in the underwear handles it, and changing your underwear twice a day keeps everything comfortable and clean.
• It is one of the most commonly reported changes after this surgery. You are far from unusual in noticing it.
• It usually reduces over the weeks and months. Mention it at follow-up if it is not improving.

The urge comes so suddenly that I sometimes leak before reaching the toilet.

• This is leaking caused by an urge you cannot hold back. It is not a failure of the surgery, and not a permanent state.
• It is much more likely while an infection is active and while the SPC balloon is still inside.
• Use pads without embarrassment, keep the route to the bathroom clear at night, and tell your team — treating the underlying irritation usually resolves it.

Starting the stream takes a second or two of effort.

• A short pause of one or two seconds before flow begins is very common in the early weeks.
• Do not strain to start. Relax, breathe out, and give it a moment.
• It usually shortens week by week as swelling settles.
• What does need review is a delay that steadily worsens over weeks alongside a thinning stream.

My urine starts as if a tap has been opened at full speed.

• A sudden, forceful start is what a healthy, unobstructed channel does. It is the opposite problem to hesitancy, and it is the better one to have.
• Sit down to urinate for the first few days if the force is hard to control, and expect some spray.
• It usually moderates as your bladder relearns a normal filling and emptying rhythm.

My flow was strong on day one but is slower now. Has the repair narrowed already?

• A steady, continuous stream, even a slower one, is reassuring — it argues against a mechanical blockage.
• Swelling and infection commonly reduce the speed for days to weeks.
• Note whether it is improving or worsening week by week. That trend is what your surgeon needs, far more than any single bad day.
• A recurring narrowing typically shows as a progressively weaker, thinner or forked stream over months, not a fluctuating one over days.

My urine sprays or splits into two streams.

• It often improves as swelling settles and the opening recovers from weeks of catheterisation.
• Sit down to urinate for a while if it is making a mess. That is a practical fix, not a defeat.
• Mention it at follow-up if it persists beyond a few months.

I have a fever.

• Fever at this stage most often means a urinary tract infection, and it is the one symptom that should never be watched at home.
• Contact your urology team, an out-of-hours service or Emergency straight away. Do not wait for morning, and do not wait to see whether it settles — especially with chills, shivering or back pain.
• Ask specifically for a urine routine and culture so the treatment can be matched to the organism.
• Keep drinking fluids unless you have been told otherwise.

I am rushing to the toilet every 15 minutes and cannot sleep.

• Ask your doctor whether the SPC should be opened to free drainage for a while. That takes the pressure off the bladder and is often what breaks the cycle.
• Ask whether a bladder relaxant medicine should be started or its strength increased for this period.
• Check the taping first — a tube under tension makes this dramatically worse.
• If it comes with fever or burning, treat it as an infection and get a urine test.

Should I still be on a bladder relaxant medicine now that the penile catheter is out?

• The SPC balloon is still inside your bladder, so the main trigger for spasms has not gone away.
• Symptoms often return quickly if a bladder relaxant medicine is stopped while the SPC is still in.
• If spasms are severe, ask whether the strength can be increased for this period. Adjusting it up when irritation peaks, and stopping it once the SPC is out, is a common pattern.

I have taped my clamped SPC facing upwards so that it is easier to move around. Is that all right?

• Untape it and let the tube hang naturally downward towards your thigh, then secure it there.
• Leave a loose loop of slack at the skin so hip and trunk movement does not tug on the tube.
• If strange sensations started when you changed the taping, they usually settle within hours of putting it back.

I can feel the SPC when I change position, and sometimes it feels like fluid is shifting inside me.

• Sitting up, twisting, leaning forward or lying on your side will each produce a different sensation.
• A vague sense of fluid moving, sloshing or being out of balance inside the lower abdomen is commonly described, and is harmless.
• Reclining slightly rather than sitting bolt upright reduces pressure through the pelvic floor.
• All of it stops once the catheter is removed.
• A pillow between the knees on your side, or under the knees on your back, settles most of it. Lying face down is the one position to avoid.

I feel a twitch or pinch at the tip of my penis, even though nothing is there.

• One of the most confusing sensations of this phase, and one of the most harmless. Nothing is happening at the tip itself.
• It fades as the SPC comes out and the inflammation settles.

Since the penile catheter came out, I have had no erections at all.

• If you were having erections before removal, your nerves and blood supply are demonstrably intact.
• Return is usually gradual — night-time and early-morning erections first, then the rest.
• Give it weeks rather than days, particularly while an infection or fever is active.
• If nothing has returned by around three months after everything else has settled, raise it. There are effective treatments, and asking early is sensible.

My testicles are hanging low again even in tight underwear.

• No pain and no heaviness means there is nothing structural to worry about.
• Keep using a snug V-cut brief; it will tighten again as your temperature normalises and inflammation settles.
• If heaviness or a dragging ache develops, your doctor may suggest a scrotal ultrasound to check for a varicocele. It is a quick, painless scan.

Has the surgery damaged the muscles that hold my scrotum up? The incision was right there.

• Nothing in this operation cuts the muscles that position the scrotum.
• Baseline tone typically returns over a few weeks once you stop relying on constant tight support.

What actually happens during the SPC removal procedure?

• The balloon is deflated with a syringe and the tube is slid out. It takes seconds.
• Expect an odd deep pulling sensation and a moment of stinging, then relief.
• No stitches are needed. A dressing goes over the site and the tract closes on its own.
• Many people are asked to pass urine normally first, so the team can confirm the repair is working before the safety net is removed.
• You can usually go home the same day and get back to ordinary movement quickly.

Urine is leaking from the hole in my abdomen. How long until it closes?

• Leakage is usually heaviest in the first day or two, then reduces steadily.
• Change the dressing whenever it is wet and keep the surrounding skin dry.
• Emptying your bladder regularly, and not holding on, helps it close faster.
• Tell your team if it is still leaking meaningfully after about a week, or if the site becomes red, hot or painful.

My SPC has been removed and there is a bandage over the site. What precautions should I take so urine or blood does not leak out?

• Your doctor will usually apply a tight pressure dressing for the first day or two. Leave that one alone unless told otherwise.
• After that, change it yourself daily for at least a week, and any time it becomes wet or soiled.
• Pass urine regularly and do not hold on. A full bladder raises the pressure inside and pushes urine out through the closing tract.
• Avoid heavy lifting, straining and hard coughing for the first week. Each one spikes abdominal pressure.
• Press a clean pad gently over the site when you cough or sneeze.
• Keep the skin around it dry. Shower rather than soak, and pat dry before redressing.
• Avoid tight waistbands sitting directly on the site.
• Leakage should reduce every day. Tell your team if it is still significant after about a week, or if the site becomes red, hot or painful, or you develop a fever.

I still need to pass urine often, even though the SPC is out.

• Most of the spasms and urgency usually go within a day or two of the tube coming out. Mild frequency can take longer.
• Expect it to keep improving week by week as your bladder gets used to filling properly again.
• If you are on a bladder relaxant medicine, ask your doctor when and how it should be stopped rather than simply stopping it.
• Tell your team if frequency is not settling after a few weeks, or if it comes with burning or fever.

I suddenly cannot pass urine at all.

• With no catheter in place, being unable to pass urine is a medical emergency. Go to Emergency the same hour.
• Warning signs in the hours before: a stream that gets thinner and thinner, needing to strain, and a lower abdomen that feels increasingly full, hard or painful.
• Tell them you have had a urethroplasty. It changes how they will manage it, and a catheter should not be forced through a fresh repair.

How do I know the repair is actually working?

• Uroflowmetry — you urinate into a machine that measures your flow rate. Painless, and it takes minutes.
• It is typically repeated at intervals through the first year and then less often. Follow whatever schedule your surgeon sets.
• Do not skip these because you feel fine. Narrowing shows up on the graph long before you notice symptoms.
• Keeping your own note of flow, stream shape and any straining between visits is genuinely useful at appointments.
• For most people the answer to the question you have been carrying for months — will I ever pass urine normally again? — is yes. Urethroplasty has a high long-term success rate, and most men return to an ordinary stream and an ordinary life.
• A minority need a further endoscopic procedure, and a small number need a repeat operation. Ask your surgeon what the numbers are for a stricture like yours.

What are the warning signs that the narrowing is coming back?

• A stream that becomes progressively weaker, thinner, forked or sprayed over weeks to months.
• Needing to strain to start or to keep the flow going.
• Taking much longer to empty, or dribbling at the end.
• Repeated urinary infections.
• A sudden return of retention — that needs same-day help.
• Most recurrences happen in the first year, which is exactly why follow-up is front-loaded into that period.

There is a firm lump or ridge in my perineum where the scar is.

• Surgical scars often feel thickened and hard for several months before softening.
• The area may stay slightly numb, or oddly sensitive, for a long time.
• Get it checked if it grows, becomes painful or red, or starts discharging.

When can I go back to work, the gym, sex and cycling?

• Desk work: often within days to a couple of weeks of catheter removal.
• Walking: encouraged early, building up gradually.
• Gym, lifting and running: commonly around six weeks, and only after clearance.
• Sex: commonly around four to six weeks after catheter removal. Expect the first few times to feel strange rather than painful.
• Cycling and horse riding: the longest wait, often three months or more, because perineal pressure is exactly what this area cannot tolerate while healing. Ask specifically, and consider a cut-out saddle when you return.

In what phased manner can I resume regular activities?

• Week 1 (site still closing): walking indoors, light desk work from home, short outings. Nothing heavier than about 5 kg. No cycling, no gym, no sex.
• Week 2: longer walks outdoors, back to office desk work, short drives once you are off strong painkillers and can brake sharply without hesitating.
• Weeks 3–4: normal daily routine, stairs, light household work, walks of 30–45 minutes. Still no lifting, gym or cycling.
• Weeks 4–6: gentle gym — light cardio, upper body, no heavy lower-body or core work. Sex is commonly allowed around this point once your surgeon clears you. Expect the first few times to feel strange rather than painful.
• Weeks 6–8: build weights back gradually, start running, resume swimming once the site is fully closed and dry.
• Month 3 onwards: cycling and horse riding, after specific clearance, ideally with a cut-out saddle. Contact sport around the same point.
• Ongoing: keep your flow tests even when everything feels normal.
• Move to the next step only when the current one causes no pain, no fresh bleeding and no change in your stream. If any of those appear, drop back a step for a week.

Will my erections come back to normal?

• Recovery is typically gradual over weeks to months, often with night-time erections returning first.
• A period of erectile difficulty after this surgery is common, and for most men it is temporary. In one study that followed men after urethroplasty on the front part of the urethra, nearly all of those affected recovered fully, at an average of about six months.¹
• Repairs in the bulbar urethra affect erections more often than repairs further forward. Injuries and repairs further back, near the prostate, carry a higher risk again.
• Recovery tends to be slower in older men.
• Anxiety about any genital surgery plays a real part in this, quite apart from anything physical — and it eases as confidence returns.
• Some men notice reduced rigidity or sensitivity that continues improving for up to a year.
• If there is no improvement by around three to six months, ask for a review. Erectile dysfunction is a recognised, well-documented outcome here — not a rare freak result, not something you caused, and treatable. Urologists expect the question.

1. Erickson BA, Granieri MA, Meeks JJ, Cashy JP, Gonzalez CM. Prospective analysis of erectile dysfunction after anterior urethroplasty: incidence and recovery of function. Journal of Urology, 2010;183(2):657–661. Of 52 men, 20 developed erectile dysfunction after surgery and 18 of those recovered fully, at a mean of 190 days.

What will ejaculation be like the first time?

• Commonly reported: weaker force, more of a dribble than a spurt, or a delay before anything appears. A weaker ejaculation is one of the most frequently described changes after this surgery.
• Weaker ejaculation and after-dribble tend to turn up in the same men, which suggests they share a cause rather than being two separate problems.
• Blood-stained or brown semen in the first few ejaculations is common and usually settles. It is old blood clearing from the repair site.
• Some men notice reduced volume, or the sensation of climax with little fluid.
• Mention it at follow-up if it does not improve over a few months.

Will this affect my fertility?

• This condition and its repair affect the tube semen travels through, not the testes that make sperm.
• Delivery can be affected if ejaculation is weak or goes backwards into the bladder — a mechanical issue rather than a sperm-quality one.
• If you are planning a family, say so at follow-up. A semen analysis a few months on gives a clear answer, and options exist if delivery is the problem.

Will my life be totally normal again?

• Passing urine: most men return to an ordinary stream and stop thinking about it. Urethroplasty has a high long-term success rate.
• Work, travel, exercise: back to normal once your surgeon clears you, with no permanent restrictions for most people.
• Sex: usually returns to how it was, though erections and ejaculation can take months to settle fully.
• Cycling and riding: generally possible again after your surgeon clears you, often with a cut-out saddle. This is the one activity worth being deliberate about.
• What does persist: a scar in the perineum, sometimes a patch of altered sensation nearby, and a follow-up schedule for a couple of years.
• The honest caveat: a minority need a further endoscopic procedure and a small number need a repeat operation. That is why the flow tests matter even when you feel fine.
• Most people, a year on, describe this as something that happened to them rather than something they still live with.