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  • One-sided Dorsal Onlay Urethroplasty

    About the Author

    Dr. Alex J Vann MDi on urologybook.com

    Dr. Alex Vanni

    Dr. Alex Vanni MD is a senior staff member at Lahey Hospital and Medical Center specializing in Trauma and Reconstructive Urology. He is an expert in complex genitourinary reconstruction including urethral stricture disease, rectourethral fistulas, concealed (buried) penis repair, genitourinary trauma, Peyronie’s disease, and post-prostatectomy incontinence.

    Dr. Vanni is a graduate of Princeton University and earned his medical degree from the University of Colorado. He completed a 6 year urology residency at the Lahey Clinic, followed by a fellowship in Trauma and Reconstructive Urology from the University of Washington. He has published numerous manuscripts and book chapters, and is active in developing cutting edge reconstructive techniques.

    Dr. Vanni is a member of the Trauma and Urologic Research Network of Surgeons (TURNS-http://turnsresearch.org).  Lahey Hospital and Medical Center is one of 12 centers that collaborate in the study of patients treated for a variety of conditions in trauma and reconstructive urology, including urethral stricture surgery, male incontinence, and a variety of other conditions.

    Introduction

    Several surgical techniques exist for urethral reconstruction related to stricture disease.

    Advantages of the one-sided dorsal onlay urethroplasty:

    1. Allows 1-stage treatment of panurethral strictures
    2. Preserves the lateral circulation of urethra
    3. Avoids penile incision

     

    Preoperative Considerations

    1. Positioning: High lithotomy with Yellofin stirrups to avoid pressure or weight on the calf or ankle
    2. Special equipment: Bougie a boule, 5 Fr Fogarty balloon

    Surgical Technique

    -Place 3-0 silk retraction suture on glans

    -Use a 22 Fr bougie a boule to demarcate the distal extent of stricture

    -Midline perineal incision

    -Identify the bulbospongiosus muscle and divide this near the left corporeal body if necessary

    -5 Fr Fogarty balloon used to identify the proximal extent of stricture

    -Mobilize the left side of corpus spongiosum proximally and distally as necessary, everting the penis through the perineal incision for the distal dissection

    -The right side of the lateral urethral circulation should be preserved in this dissection

    -A 20 Fr red rubber catheter is then place and the urethra opened dorsally over the catheter

    -The entire strictured area is then opened proximally and distally to 28 Fr

    -If the stricture involves the distal penile urethra or fossa navicularis region, the penis can be everted with a babcock

    -A dorsal incision can be made through the fossa navicularis and connected to the penile urethra for subsequent graft placement

    -The stricture length should be made with the inverted penis on stretch

    -The buccal mucosa graft(s) (BMG) are then spread fixed to the corpora with 5-0 absorbable monofilament suture

    -Each apex is closed with interrupted 5-0 absorbable monofilament suture

    -The right side of the BMG is anastamosed to the urethral plate with a running 5-0 absorbable monofilament suture

    -Place 16 Fr silastic foley catheter

    -Compete the anastomosis on the left side of the BMG with 5-0 absorbable monofilament suture between the tunica albuginea, BMG and urethra

    -Reappoximate bulbospongiosus muscle with 4-0 absorbable suture

    -Close Colle’s fascia with a 4-0 absorbable suture

    -Close skin with 4-0 absorbable suture

     

    Reference

    1. Kulkarni, S., Barbagli, G., Sansalone, S. and Lazzeri, M. (2009), One-sided anterior urethroplasty: a new dorsal onlay graft technique. BJU International, 104: 1150–1155.