V06-04 NEW SURGICAL TECHNIQUE: INTRAURETHRAL TUBE IN TUBE PEDICLED PREPUTIAL FLAP FOR OBLITERATIVE STRICTURES

Abstract

You have accessJournal of UrologyLower-Tract Reconstruction I: Sling/ Sphincter/ Penile & Urethral Reconstruction (V06)1 Apr 2020V06-04 NEW SURGICAL TECHNIQUE: INTRAURETHRAL TUBE IN TUBE PEDICLED PREPUTIAL FLAP FOR OBLITERATIVE STRICTURES Pankaj Joshi* and Sanjay Kulkarni Pankaj Joshi*Pankaj Joshi* More articles by this author and Sanjay KulkarniSanjay Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000885.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of Obliterative and recurrent long segment bulbar strictures is challenging. Few options exist such as double face urethroplasty or combined use of graft and flap. In majority of reported literature, the native urethra is excised and reconstruction is performed. This native urethra actually carries retrograde blood flow through bulbourethral arteries. We describe a new technique of preserving the native spongiosa and using it as cover for substitution decreasing the risk of diverticulum formation. METHODS: Ours is a tertiary care referral center for urethroplasty with experience of more than 4500 Urethroplasties in last 2 decades. This is a series of 3 patients operated between Jan 2019-March 2019.All had near Obliterative proximal bulbar stricture. Etiology was idiopathic in 1 patient and post TURP in 2 patients.2 patients had prior dorsal Onlay urethroplasties. RGU and MCU were performed. Perineal incision with ventral urethrotomy in proximal bulbar urethra was performed. The scarred urethral plate was excised. There was a gap of 3 cm between the healthy mucosal ends proximally and distally. Pedicled preputial flap was performed, transposed to perineum and tubularised over a 14 Fr Silicone catheter .The tube was anastomosed to the proximal urethral mucosa and then distally. The ventral urethrotomy which now had the spongiosa was closed over as a cover . RESULTS: Foleys catheter was kept for 6 weeks. On catheter removal, Uroflow was performed. Patients were followed up every 3 months with Uroflow, Ultrasound and urine culture .All 3 patients had good flow till last follow up.None of them developed infections.All complained of minimal post micturition dribbling. CONCLUSIONS: Obliterative redo urethral strictures merit reconstruction. Proximal post TURP strictures are not recommended to be treated with dorsal approach. Urethral substitution would require urethra transection, compromising the blood flow. This is a novel intraurethral tube in tube, flap technique which is vascular preserving and useful for management for such subset of patients. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e557-e557 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pankaj Joshi* More articles by this author Sanjay Kulkarni More articles by this author Expand All Advertisement PDF downloadLoading ...