URETHRAL RECONSTRUCTION
Dr.Palminteri
http://www.urethralsurgery.com


WHAT IS THE URETHRAL RECONSTRUCTION

The diseases of the urethra very often require the use of surgery. Urethral strictures and urethral stenoses are treated by various techniques. The treatment for urethral strictures include numerous options, such as dilation, urethrotomy, stent and reconstructive surgical techniques and emphasized that no one technique is appropriate for all stricture diseases. Dilation and urethrotomy continue to be the most commonly used techniques, but they have a high failure rate with recurrence in 47.6% of patients and many patients progress to surgical repair. Persistent use of dilation or urethrotomy for the treatment of urethral strictures may be the result of unfamiliarity with literature and inexperience with urethroplasty surgery. Open urethral reconstruction is regarded as the gold standard treatment for urethral strictures.  Nevertheless, urethroplasty is not a routine operation and a lack of the necessary skills should prompt a referral to a specialist skilled in urethroplasty.

THE URETHROPLASTY
 There are two types of urethral reconstruction. There are many surgical techniques with or without grafts that we can perform to repair urethral  strictures and at the same time permit the aesthetic reconstruction of the glans and the penis. Basically, the surgical technique for urethral reconstruction is selected according to the etiology of the urethral stricture disease and must also be based on the proper anatomic characteristics of the penile tissues to ensure flap or graft take and survival. Urethroplasty is a open surgical procedure for urethral reconstruction to treat urethral stricture. Urethroplasty can be performed by 2 methods; primary repair which involves complete excision of the narrowed part of the urethra. The proximal and distal patent parts are then rejoined. The second method of Urethroplasty utilizes tissue transfer or free graft technique. In this method, tissue is grafted from foreskin, or buccal mucosa and is used to enlarge the strictured (narrowed) segment of the urethra. Urethroplasty is performed under general anesthesia. Two Urethroplasty techniques are popularly used:
  •     Anastomotic Technique - In this method of Urethroplasty, the narrowed part of the urethra is cut and the proximal and distal parts of the urethra are re-joined, a foley's catheter will be left in for the next 2 weeks to ensure complete healing and repair. This method of Urethroplasty is used for small urethral strictures i.e. less than 2 cm wide.
  •  Tissue Transfer - In this method of Urethroplasty, Skin and Tissue is Grafted from a non-hair bearing part of the body like the buccal mucosa or bladder mucosa. Free grafts like Full Thickness Skin Grafts or Split Thickness Skin Grafts can be used for this purpose. Tissue Transfer Urethroplasty can be also be carried out in 2 stages if sufficient local tissue is not available for a Skin Flap Procedure and local tissue factors are not suitable for a free graft one stage procedure.