�UroToday.com - Urologists in practice will likely be confronted with bulbous urethral stricture disease. Certainly in that location will be other patients who confront to the office, merely most of the techniques for transaction with strictures, other than in the bulbous urethra, are more than the general urologist in practice may desire to tackle. However, there are strictures of the bulbous urethra which tin be addressed without to a fault much difficultness by the urologist world Health Organization sees a fair number of strictures in his practice, and who is motivated to proceed with reconstruction. The most common error in addressing strictures of the bulbous urethra is to misinterpret the extent of spongiofibrosis. If one has a narrow caliber segment in the bulbous urethra, even if the urethra proximal to that narrow caliber segment appears to be of adequate calibre, it indeed may as well be involved with the process of spongiofibrosis, and when the hydrodilation of the minute caliber percentage of the stricture is relieved, the proximal urethra will then go on to tighten down and the urologist will be faced with a recurrence of stricture. Thus the evaluation of the length of spongiofibrosis is important to the success of any operation to address it.
There is ample literature which states that dilation and internal urethrotomy have a distinct space in the management of bulbous urethral stricture disease. There is also literature which states that non every patient with bulb-shaped stricture disease deserves to have dilation or an internal urethrotomy.
The lit is comparatively uniform in stating that the patient who whitethorn enjoy winner from an internal urethrotomy or dilation with curative intent will have a short segment stricture (1 to 1 1?2 cm.), testament have relatively superficial spongiofibrosis, and the stricture will be placed in the bulbous urethra. The success rate for internal urethrotomy and dilatation for strictures other than in the bulbous urethra is dreadfully poor. There is too ample literature which states that insistent dilation and internal urethrotomy never go to cure, but they certainly continue to spreading the stricture disease, devising reconstruction more difficult, and making the results of subsequent reconstruction less than they would have been should the stricture have been addressed initially.
With regards to open reconstruction, the cutting out of the stricture and primary anastomosis has been declared, and rightfully so, the gold standard. Its limitation is that excision and master anastomosis does consume a length of bulbous corpus spongiosum, and when one tries to address strictures that are too long, one risks the foundation of chordee and/or penile shortening.
Certain techniques which allow for the drawn-out use of excision with primary inosculation will be addressed. Likewise the proficiency of vessel sparing, deletion and primary anastomosis for very proximal bulbous strictures will be reviewed.
Certainly not all strictures can be addressed with cutting out and elemental anastomosis, and techniques of tissue transfer will be addressed. The behavior of graft and flaps, the techniques of transfer, and the expectations of the unit of transfer will be covered in some detail. Cases will be used to illustrate stream techniques of graft and flap onlay, and graft and beat augmented inosculation.
Presented by: Gerald H. Jordan, MD, FACS, FAAP, at the Masters in Urology Meeting - July 31, 2008 - August 2, 2008, Elbow Beach Resort, Bermuda.
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