One stage anterior urethral reconstruction of the pendulous urethra. A viable option for long strictures

One stage anterior urethral reconstruction of the pendulous urethra. A viable option for long strictures

12th South Eastern European Meeting, 23-24 September 2016, Sarajevo (BA) 70 One stage anterior urethral reconstruction of the pendulous urethra. A v...

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12th South Eastern European Meeting, 23-24 September 2016, Sarajevo (BA)

70

One stage anterior urethral reconstruction of the pendulous urethra. A viable option for long strictures Eur Urol Suppl 2016; 15(10);e1308

Papaefstathiou E., Gkekas C., Stafilarakis D., Kalyvas V., Malioris A., Papathanasiou M. 424 General Army Hospital, Dept. of Urology, Thessaloniki, Greece INTRODUCTION & OBJECTIVES: Long fibrotic strictures of the pendulous portion of the anterior urethra are extremely difficult to treat owing to the compromised vascular supply to the area, the loose supportive tissues and the added iatrogenic damage during dissection. Many advocate the employment of a two stage reconstruction utilizing grafts and allowing a long enough period between the two stages before tubularization. We present our experience and follow up of a patient with a completely obliterated long (6cm) stricture of the posterior urethra who underwent a single stage reconstruction. MATERIAL & METHODS: A 67 year old male with completely obliterated anterior urethra after TURp and two failed previous urethrotomy attempts presented to our clinic bearing a subrapubic diversion. Retro- and antegrade urethrography showed a long anterior urethral stricture with pause of continuity into its midportion. He underwent a urethroplasty utilizing a single cheek harvested buccal muccosa graft. Due to the lengthy defect the graft included also a part of the lower lip producing a J shaped defect in the mouth. The penis was degloved and the strictured, fibrotic urethra was ventrically opened along its entire strictured length sparing its glandular portion. The incision was also carried through the luminal side of the dorsal urethral as deep as the corporal bodies. The defect was trimmed according to the Asopa principle and the graft was quilted on the corpora cavernosa. A 16Ch catheter was introduced into the urethra and the ventral wall was reapproximated with absorbable sutures.

Eur Urol Suppl 2016; 15(10);e1308

12th South Eastern European Meeting, 23-24 September 2016, Sarajevo (BA)

70

One stage anterior urethral reconstruction of the pendulous urethra. A viable option for long strictures Eur Urol Suppl 2016; 15(10);e1309

Eur Urol Suppl 2016; 15(10);e1309

12th South Eastern European Meeting, 23-24 September 2016, Sarajevo (BA)

70

One stage anterior urethral reconstruction of the pendulous urethra. A viable option for long strictures Eur Urol Suppl 2016; 15(10);e1310

RESULTS: At 21 days the catheter was removed. A RUG and a VCUG showed patency of the neourethra. At 40 days the penis developed a painful induration. It was cavernositis which was treated with orally administered fluoroquinolones and the situation completely subsided in 4 weeks. The patient performs biweekly intermittent self catheterizations. At 8 months follow up the urethra exhibits a satisfying patency and a urethroscopy revealed normal epithelization. CONCLUSIONS: One stage reconstruction in long and fibrotic anterior urethral strictures of the pendulous urethra is a reliable approach yielding the advantage of a less operative morbidity compared to the established two staged technique.

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