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Dorsolateral onlay urethroplasty for anterior urethral strictures by a unilateral urethral mobilization approach.

Singh BP, Pathak HR, Andankar MG - Indian J Urol (2009)

Bottom Line: The buccal mucosa graft was secured on the ventral tunica of the corporal bodies.Mean and median.After a follow-up of 12-30 months, one recurrence developed and 1 patient needed an internal urethrotomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India.

ABSTRACT

Context: For management of long segment anterior urethral stricture, dorsal onlay urethroplasty is currently the most favored single-stage procedure. Conventional dorsal onlay urethroplasty requires circumferential mobilization of the urethra, which might cause ischemia of the urethra in addition to chordee.

Aims: To determine the feasibility and short-term outcomes of applying a dorsolateral free graft to treat anterior urethral stricture by unilateral urethral mobilization through a perineal approach.

Settings and design: A prospective study from September 2005 to March 2008 in a tertiary care teaching hospital.

Materials and methods: Seventeen patients with long or multiple strictures of the anterior urethra were treated by a dorsolateral free buccal mucosa graft. The pendulous urethra was accessed by penile eversion through the perineal wound. The urethra was not separated from the corporal bodies on one side and was only mobilized from the midline on the ventral aspect to beyond the midline on the dorsal aspect. The urethra was opened in the dorsal midline over the stricture. The buccal mucosa graft was secured on the ventral tunica of the corporal bodies.

Statistical analysis used: Mean and median.

Results: After a follow-up of 12-30 months, one recurrence developed and 1 patient needed an internal urethrotomy.

Conclusions: A unilateral urethral mobilization approach for dorsolateral free graft urethroplasty is feasible for panurethral strictures of any length with good short-term success.

No MeSH data available.


Related in: MedlinePlus

(a) Limited urethral mobilization from midline ventrally to beyond midline dorsally, (b) urethral incision at dorsal midline (12 O'clock), (c) graft sutured to medial (right) urethral margin, and (d) graft sutured to lateral (left) urethral margin
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Figure 0001: (a) Limited urethral mobilization from midline ventrally to beyond midline dorsally, (b) urethral incision at dorsal midline (12 O'clock), (c) graft sutured to medial (right) urethral margin, and (d) graft sutured to lateral (left) urethral margin

Mentions: An intra-operative urethroscopy was performed to check the caliber of the narrow urethra and the remaining urethra. We performed the onlay procedure only if the urethra was of at least 6 fr. diameter. Urethroplasty was started by a midline perineal approach, with the patient in a high lithotomy position. The penis was everted through the perineal incision. The urethra was mobilized from the midline on the ventral aspect to beyond the midline on the dorsal aspect [Figure 1a]. Fascia and vascular attachments on the other side of the urethra were left intact. Maximum distal and proximal limits of dissection were meatus and bulbomembranous junction. The urethra was incised open in the midline dorsally [Figure 1b]. Buccal mucosal grafts (from one or both the cheeks) of required length and width were taken. The length of the area to be grafted was measured by the incised length of the urethra. Graft sizing is appropriate by this method; hence, preventing chordee. Proximally, the graft was sutured to the open urethra by a few interrupted sutures at the apex and at the medial urethral margin. Then, one edge of the graft was sutured to the medial urethral margin, which is in place and fixed to the corpora [Figure 1c]. This was performed by continuous suturing using 4/O Vicryl until the distal apex. At the distal apex, few interrupted sutures were taken. Quilting sutures were applied to keep the graft opposed to the tunica and to prevent buckling of the graft. A 14 Fr Foleys catheter was kept. The other margin of the graft was sutured to the lateral margin of the urethra and the tunica of corpora [Figure 1d]. These three tissues were taken together while approximating the lateral edge, thereby anchoring both graft and urethral margin to the coporal tunica. During the entire procedure, care was taken to prevent stretching of the graft, which may result in chordee. A corrugated drain was kept. The bulbospongiosus muscle was approximated in the midline. Subcutaneous tissues and skin were closed with interrupted absorbable sutures.


Dorsolateral onlay urethroplasty for anterior urethral strictures by a unilateral urethral mobilization approach.

Singh BP, Pathak HR, Andankar MG - Indian J Urol (2009)

(a) Limited urethral mobilization from midline ventrally to beyond midline dorsally, (b) urethral incision at dorsal midline (12 O'clock), (c) graft sutured to medial (right) urethral margin, and (d) graft sutured to lateral (left) urethral margin
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2710067&req=5

Figure 0001: (a) Limited urethral mobilization from midline ventrally to beyond midline dorsally, (b) urethral incision at dorsal midline (12 O'clock), (c) graft sutured to medial (right) urethral margin, and (d) graft sutured to lateral (left) urethral margin
Mentions: An intra-operative urethroscopy was performed to check the caliber of the narrow urethra and the remaining urethra. We performed the onlay procedure only if the urethra was of at least 6 fr. diameter. Urethroplasty was started by a midline perineal approach, with the patient in a high lithotomy position. The penis was everted through the perineal incision. The urethra was mobilized from the midline on the ventral aspect to beyond the midline on the dorsal aspect [Figure 1a]. Fascia and vascular attachments on the other side of the urethra were left intact. Maximum distal and proximal limits of dissection were meatus and bulbomembranous junction. The urethra was incised open in the midline dorsally [Figure 1b]. Buccal mucosal grafts (from one or both the cheeks) of required length and width were taken. The length of the area to be grafted was measured by the incised length of the urethra. Graft sizing is appropriate by this method; hence, preventing chordee. Proximally, the graft was sutured to the open urethra by a few interrupted sutures at the apex and at the medial urethral margin. Then, one edge of the graft was sutured to the medial urethral margin, which is in place and fixed to the corpora [Figure 1c]. This was performed by continuous suturing using 4/O Vicryl until the distal apex. At the distal apex, few interrupted sutures were taken. Quilting sutures were applied to keep the graft opposed to the tunica and to prevent buckling of the graft. A 14 Fr Foleys catheter was kept. The other margin of the graft was sutured to the lateral margin of the urethra and the tunica of corpora [Figure 1d]. These three tissues were taken together while approximating the lateral edge, thereby anchoring both graft and urethral margin to the coporal tunica. During the entire procedure, care was taken to prevent stretching of the graft, which may result in chordee. A corrugated drain was kept. The bulbospongiosus muscle was approximated in the midline. Subcutaneous tissues and skin were closed with interrupted absorbable sutures.

Bottom Line: The buccal mucosa graft was secured on the ventral tunica of the corporal bodies.Mean and median.After a follow-up of 12-30 months, one recurrence developed and 1 patient needed an internal urethrotomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India.

ABSTRACT

Context: For management of long segment anterior urethral stricture, dorsal onlay urethroplasty is currently the most favored single-stage procedure. Conventional dorsal onlay urethroplasty requires circumferential mobilization of the urethra, which might cause ischemia of the urethra in addition to chordee.

Aims: To determine the feasibility and short-term outcomes of applying a dorsolateral free graft to treat anterior urethral stricture by unilateral urethral mobilization through a perineal approach.

Settings and design: A prospective study from September 2005 to March 2008 in a tertiary care teaching hospital.

Materials and methods: Seventeen patients with long or multiple strictures of the anterior urethra were treated by a dorsolateral free buccal mucosa graft. The pendulous urethra was accessed by penile eversion through the perineal wound. The urethra was not separated from the corporal bodies on one side and was only mobilized from the midline on the ventral aspect to beyond the midline on the dorsal aspect. The urethra was opened in the dorsal midline over the stricture. The buccal mucosa graft was secured on the ventral tunica of the corporal bodies.

Statistical analysis used: Mean and median.

Results: After a follow-up of 12-30 months, one recurrence developed and 1 patient needed an internal urethrotomy.

Conclusions: A unilateral urethral mobilization approach for dorsolateral free graft urethroplasty is feasible for panurethral strictures of any length with good short-term success.

No MeSH data available.


Related in: MedlinePlus