Miko24
Guru
PREOPERATIVE DIAGNOSIS: Urethral Stricture
POSTOPERATIVE DIAGNOSIS: urethral stricture
PROCEDURES PERFORMED: Non-transecting anastomotic urethroplasty
FINDINGS:
1. L1 S1a E2 urethral stricture
INDICATIONS: 73 male w/ urethral stricture
PROCEDURE DETAILS:
The patient was brought to the operating room and transferred to the operating room table. Anesthesia was initiated without
complication.
The patient was positioned into high dorsal lithotomy. All pressure points were padded. Pre-procedure timeout was performed
with all team members confirming correct patient and correct procedure.
The perineal midline was marked out for an incisional length of 5 to 6 cm, and the skin was incised with a 15 blade scalpel.
This was carried deeper with electrocautery through Colles' fascia, perineal fat until the bulbospongiosus muscle was
encountered. The perineal Bookwalter retractor was then set up. The lateral edges of the incision were retracted with sharp blue
hooks, the proximal and distal extents were retracted with body wall retractors.
The ventral surface of the urethra was identified at the location where the bulbospongiosus muscle inserted. This layer was
encountered sharply. The bulbospongiosus muscle was then lifted off of the ventral surface of the urethra with a combination of
blunt dissection and sharp incision, it was then retracted posteriorly with a body wall retractor.
A plane between the dorsal surface of the urethra and the ventral corporal bodies was developed sharply at the location of the
bifurcation of the corporal bodies. Once circumferentially mobilized a vessel loop was passed around the urethra and additional
dorsal attachments were sharply divided proximally and distally. The dorsal midline of the urethra was marked out with a
marking pen. An 18 French red rubber catheter was then inserted through the urethra and passed retrograde until resistance was
encountered indicating the location of the stricture. A 15 blade was used to make a dorsal urethrotomy at this location, until the
catheter was visualized and the urethral mucosal edges were identified these were tagged with 4-0 Vicryl sutures.
The urethrotomy was extended proximally for a length of 2 cm until healthy urethral mucosa was encountered. Vicryl tacking
sutures were placed along the way. A 5-0 PDS suture was placed at the apex of the proximal urethrotomy. Passage of a 22
French Bougie A Boule urethral calibration device confirmed no further urethral stricture. A 17 French flexible cystoscope was
passed retrograde through the proximal urethrotomy into the bladder. The scope was then slowly withdrawn confirming no
further stricture and confirming the apical suture was passed through urethral mucosa.
At this point in time I decided a buccal mucosal graft was not needed.
After inspection of the health and integrity of ventral mucosal I felt a was not needed.
Six additional 5-0 PDS anastomotic sutures were placed through the proximal extent of the ureterotomy incorporating
spongiosal and mucosal tissue. The right-sided anastomotic sutures were passed over to the right side of the urethra with a right
angle. The left-sided anastomotic sutures were then placed through their corresponding location on the distal urethrotomy
ensuring inclusion of the mucosa and spongiosal tissue. A final 18 French catheter was passed through the urethra, through the
proximal urethrotomy and into the bladder and 10 mL used to inflate the balloon. The right-sided anastomotic sutures were
passed through their corresponding location on the right side of the distal urethrotomy. All the sutures were then tied down in a
watertight fashion. The urethrotomy was inspected and noted to be visually closed.
The surgical field was inspected and hemostasis was achieved with bipolar electrocautery. Irrisept solution was used for
irrigation. Arista powder was sprayed into the surgical field.
The bulbospongiosus muscle was returned to its anatomic location and secured on the ventral surface of the urethra with a 4-0
Vicryl suture. The perineal fat was reapproximated with a running 3-0 Vicryl. Colles' fascia was reapproximated with a
running 3-0 Vicryl. The skin was reapproximated with interrupted 4-0 Vicryl's. A sterile dressing with Xeroform gauze, folded
4 x 4 and Tegaderm was applied.
POSTOPERATIVE DIAGNOSIS: urethral stricture
PROCEDURES PERFORMED: Non-transecting anastomotic urethroplasty
FINDINGS:
1. L1 S1a E2 urethral stricture
INDICATIONS: 73 male w/ urethral stricture
PROCEDURE DETAILS:
The patient was brought to the operating room and transferred to the operating room table. Anesthesia was initiated without
complication.
The patient was positioned into high dorsal lithotomy. All pressure points were padded. Pre-procedure timeout was performed
with all team members confirming correct patient and correct procedure.
The perineal midline was marked out for an incisional length of 5 to 6 cm, and the skin was incised with a 15 blade scalpel.
This was carried deeper with electrocautery through Colles' fascia, perineal fat until the bulbospongiosus muscle was
encountered. The perineal Bookwalter retractor was then set up. The lateral edges of the incision were retracted with sharp blue
hooks, the proximal and distal extents were retracted with body wall retractors.
The ventral surface of the urethra was identified at the location where the bulbospongiosus muscle inserted. This layer was
encountered sharply. The bulbospongiosus muscle was then lifted off of the ventral surface of the urethra with a combination of
blunt dissection and sharp incision, it was then retracted posteriorly with a body wall retractor.
A plane between the dorsal surface of the urethra and the ventral corporal bodies was developed sharply at the location of the
bifurcation of the corporal bodies. Once circumferentially mobilized a vessel loop was passed around the urethra and additional
dorsal attachments were sharply divided proximally and distally. The dorsal midline of the urethra was marked out with a
marking pen. An 18 French red rubber catheter was then inserted through the urethra and passed retrograde until resistance was
encountered indicating the location of the stricture. A 15 blade was used to make a dorsal urethrotomy at this location, until the
catheter was visualized and the urethral mucosal edges were identified these were tagged with 4-0 Vicryl sutures.
The urethrotomy was extended proximally for a length of 2 cm until healthy urethral mucosa was encountered. Vicryl tacking
sutures were placed along the way. A 5-0 PDS suture was placed at the apex of the proximal urethrotomy. Passage of a 22
French Bougie A Boule urethral calibration device confirmed no further urethral stricture. A 17 French flexible cystoscope was
passed retrograde through the proximal urethrotomy into the bladder. The scope was then slowly withdrawn confirming no
further stricture and confirming the apical suture was passed through urethral mucosa.
At this point in time I decided a buccal mucosal graft was not needed.
After inspection of the health and integrity of ventral mucosal I felt a was not needed.
Six additional 5-0 PDS anastomotic sutures were placed through the proximal extent of the ureterotomy incorporating
spongiosal and mucosal tissue. The right-sided anastomotic sutures were passed over to the right side of the urethra with a right
angle. The left-sided anastomotic sutures were then placed through their corresponding location on the distal urethrotomy
ensuring inclusion of the mucosa and spongiosal tissue. A final 18 French catheter was passed through the urethra, through the
proximal urethrotomy and into the bladder and 10 mL used to inflate the balloon. The right-sided anastomotic sutures were
passed through their corresponding location on the right side of the distal urethrotomy. All the sutures were then tied down in a
watertight fashion. The urethrotomy was inspected and noted to be visually closed.
The surgical field was inspected and hemostasis was achieved with bipolar electrocautery. Irrisept solution was used for
irrigation. Arista powder was sprayed into the surgical field.
The bulbospongiosus muscle was returned to its anatomic location and secured on the ventral surface of the urethra with a 4-0
Vicryl suture. The perineal fat was reapproximated with a running 3-0 Vicryl. Colles' fascia was reapproximated with a
running 3-0 Vicryl. The skin was reapproximated with interrupted 4-0 Vicryl's. A sterile dressing with Xeroform gauze, folded
4 x 4 and Tegaderm was applied.