Posterior urethroplasty using a combined surgical and endoscopical technique
- uploaded: Dec 29, 2009
- Views: 503
Institution:Center for Urethral and Genital Reconstructive Surgery, Arezzo, Italy
Introduction: The video shows the posterior urethroplasty consisting of a bulbo-prostatic anastomosis by means of a combined procedure which used a surgical progressive perineal approach and an endoscopic suprapubic access.
Material and methods: Patient, 23 years old, underwent urethral surgery for posterior urethral stricture secondary to pelvic trauma.
Surgical technique: A Y-inverted perineal incision is made and the bulbar urethra is isolated and freed from the scars. The section of the perineal central tendon allows the mobilization of the proximal bulbar urethra and a better posterior access to the membraneous urethra. The bulbar urethra is detached from the corpora cavernosa. The membraneous urethra is isolated circumferentially. The median separation of the copora cavernosa facilitates the anterior access to the prostatic apex. Finally it is possible to isolate adequately the bulbar urethra-membranous urethra-prostatic apex bloc. The membraneous urethra is cut as near as possible to the prostatic apex. The suprapubic access is dilated by means of Amplaz. The flexible cystostope is inserted in the bladder and, through the bladder neck, in the prostatic urethra until the stenotic site. The perineum is transilluminated by the endoscope and the surgeon, following the light, incides the prostatic apex and identifies the proximal urethral lumen. After the resection of scarred tissue, the two urethral stumps are spatulated and a tension-free anastomosis is performed.
Results: at catheter removal after 1 month, the stricture has been repaired and the urinary continence is good.
Conclusion: In the posterior urethroplasty the progressive perineal approach allows achieving a satisfying access to the prostatic apex; the endoscopic suprapubic access is a minor invasive additional manoeuvre that facilitates the identification of the proximal urethral lumen and reduces the risk of damage to the bladder neck.
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