Abstract
The use of flaps or grafts is mandatory in patients with longer and complex strictures. In 1995-96 we described a new dorsal onlay graft urethroplasty. Over time, our original technique was better defined and changed. Now this procedure (also named Barbagli technique) has been greeted with a fair amount of enthusiasm in Europe and in the United States. The patient is placed in normal lithotomy position, and a midline perineo-scrotal incision is made. The bulbar urethra is then free from the bulbo-cavernous muscles, and is dissected from the corpora cavernosa. The urethra is completely mobilized from the corpora cavernosa, it is rotated 180 degrees, and is incised along its dorsal surface. The graft (preputial skin or buccal mucosa) or the flap is fixed and quilted to the tunica albuginea of the corporal bodies. The right mucosal margin of the opened urethra is sutured to the right side of the patch-graft. The urethra is rotated back into its original position. The left urethral margin is sutured to the left side of the patch graft and to the corporal bodies, and the grafted area is entirely covered by the urethral plate. The bulbo-cavernous muscles are approximated over the grafted area. A 16F silicone Foley catheter is left in place. Dorsal onlay graft urethroplasty is a versatile procedure that may be combined with various substitute materials like preputial skin, buccal mucosa grafts or pedicled flaps.
Highlights
The use of flaps or grafts is mandatory in patients with longer and complex strictures
A wide array of techniques is used in reconstructive surgery for bulbar urethral stricture diseases, and modifications are continuously added to them
End-to-end urethroplasty for bulbar adult-urethral stricture has greater than 95% durable cure rates and low complication rates [1]
Summary
A wide array of techniques is used in reconstructive surgery for bulbar urethral stricture diseases, and modifications are continuously added to them. Our original technique was better defined and new changes were added to it [6]. This procedure ( named Barbagli technique) has been greeted with a fair amount of enthusiasm in Europe and in the United States [7,8,9,10,11,12]. In the bulbar urethra the relationship between the spongiosum tissue and the mucosal membrane is quite different from the relationship in the penile region: the corpus spongiosum is thick in the ventral urethral surface and thin in the dorsal urethral surface. The urethral lumen is located dorsally and not centrally (Figure-1)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
