Urethroplasty

Urethroplasty is the repair of an injury or defect within the walls of the urethra. Trauma, iatrogenic injury and infections are the most common causes of urethral injury/defect requiring repair. Urethroplasty is regarded as the gold standard treatment for urethral strictures and offers better outcomes in terms of recurrence rates than dilatations and urethrotomies. It is probably the only useful modality of treatment for long and complex strictures though recurrence rates are higher for this difficult treatment group.[1]

Urethroplasty
Specialty urology

There are four commonly used types of urethroplasty performed; anastomotic, buccal mucosal onlay graft, scrotal or penile island flap (graft), and Johansen’s urethroplasty.[2]

With an average operating room time of between three and eight hours, urethroplasty is not considered a minor operation. Patients who undergo a shorter duration procedure may have the convenience of returning home that same day (between 20% and 30% in total of urethroplasty patients). Hospital stays of two or three days duration are the average. More complex procedures may require a hospitalization of seven to ten days.[3]

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These parts of the operation are common to all specific operations.

Ideally, the patient will have undergone urethrography to visualize the positioning and length of the defect. The normal pre-surgical testing/screening (per the policies of the admitting hospital, anesthesiologist, and urological surgeon) will be performed, and the patient will be advised to ingest nothing by mouth, “NPO“, for a predetermined period of time (usually 8 to 12 hours) prior to the appointed time.

Upon arrival to the preoperative admitting area, the patient will be instructed to don a surgical gown and be placed into a receiving bed, where monitoring of vital signs, initiation of a normal saline IV drip, and pre-surgical medication including IVantibiotics, and a benzodiazepine class sedative, usually diazepam or midazolam will be started/administered.[4]

The patient will be transported to the operating room and the procedures for induction of the type of anesthesia chosen by both the patient and medical staff will be started. The subject area will be prepped by shaving, application of an antiseptic wash (usually povidone iodine or chlorhexidine gluconate – if sensitive or allergic to the former), surgically draped and placed in the Lloyd-Davies position. Note: throughout the duration of the procedure, the patient’s legs will be massaged and manipulated at predetermined intervals in an attempt to prevent compartment syndrome, a complication from circulatory and nerve compression resultant from the lithotomy positioning. Some hospitals utilize the Allen Medical Stirrup System, which automatically inflates a compression sleeve applied to the thigh-portion of the stirrup device at predetermined intervals. This system is designed to prevent compartment syndrome in surgeries lasting more than six hours.[3]

At this time the surgical team will perform testing to determine if the anesthesia has taken effect. Upon satisfactory finding(s), a suprapubic catheter (with drainage system) will be inserted into the urinary bladder (to create urinary diversion during the procedure), and the chosen procedure will then be initiated.[3]

Note: The surgical procedures listed below may have small variances in the methodology used from surgeon to surgeon. Consider the following as a generalized description of each individual procedure, although every precaution was taken to ensure the accuracy of the information.

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