Hybrid minimally invasive urethroplasty for pan anterior urethral strictures (SIU 2011)
- uploaded: Sep 18, 2011
- Views: 385
Institution:All India Institute of Medical Sciences, New Dehli, India
Introduction and objectives: Pan anterior urethral strictures are difficult to manage. Urethra in such cases is fibrotic and ischemic. Herein we describe our minimally invasive hybrid technique for treating pan-anterior urethral stricture and its results.
Material and methods: From Feb. 2009 till Jan. 2011 six patients with pan-anterior urethral stricture were operated in our unit. The mean age was 36(28-51) years with mean stricture length of 14.23 cm. Three of these were catheter induced and three were due to BXO. The patients were operated in the lithotomy position. A small vertical perineal incision was made. A unilateral mobilisation of bulbospongiosus muscle was carried out. A full thickness deep visual internal urethrotomy was made employing cold knife using pediatric /adult urethrotome to reach corpus cavernosum as the graft bed. A 14-16 cm long, 15-16 mm wide buccal mucosa graft (5 patients)/ lingual mucosa (1 patient) was harvested. A 2.5 cm dorso- lateral urethrotomy was done in the proximal bulbar urethra. The graft was incorporated in the urethra through the meatus and slid into an exact position till the urethrotomy ( as demonstrated in the video). The graft was sutured dorsally at the site of urethrotomy with 3-4 fixation sutures on one (left) side. A 16 fr. Foleys catheter was placed over the pre-placed guide wire. The other (right) edge of the graft was now sutured to the right edge of the urethrotomy. The graft was then sutured distally at the meatus along with meatoplasty. A meticulous pressure dressing was done to stabilise the graft on its bed for the next seven days.
Results: None of the patients developed oral complications. One patient developed perineal wound infection. Rest of the patients had uneventful convalescence. The Foleys catheter was removed after three weeks. Our mean follow up time is 11(2-24) months. All patients are voiding well following surgery with no adjuvant procedures.
Conclusions: Our hybrid technique provides good initial results. It combines benefits of minimal urethral mobilisation and optimal graft fixation while preserving the vascularity of the urethra.
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