V08-10 ENDOSCOPIC URETHROPLASTY FOR MANAGEMENT OF MALE MEMBRANOUS URETHRAL STRICTURE

Abstract

You have accessJournal of UrologyCME1 Apr 2023V08-10 ENDOSCOPIC URETHROPLASTY FOR MANAGEMENT OF MALE MEMBRANOUS URETHRAL STRICTURE Garrett Ungerer, Jayson Kemble, and Jonathan Warner Garrett UngererGarrett Ungerer More articles by this author , Jayson KembleJayson Kemble More articles by this author , and Jonathan WarnerJonathan Warner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral stricture disease remains a challenging urologic problem, often requiring open repair using grafts or tissue flaps. While endoscopic management offers advantages including minimizing additional surgical trauma to the already scarred urethra and pelvic floor, urethral dilation and/or urethrotomy have been shown to have less durable outcomes compared to other urethroplasty techniques (end-to-end, graft, flap, or two-stage urethroplasty). In this video, we demonstrate a minimally invasive endoscopic approach to urethroplasty using buccal grafting for management of male membranous urethral stricture disease. METHODS: The procedure was performed for management of an 8mm flow limiting stricture within the membranous urethra in a male patient with prior history of prostate cancer managed by radiation who subsequently developed an 8mm flow limiting membranous stricture. The patient is prepped in dorsal lithotomy position. Under direct visualization via cystoscopy, the stricture is first balloon dilated. Next, a posterior strip of the superficial mucosa is resected from the bladder neck to just distal to the area of stricture, creating a 1cm wide bed for the graft to lay. After the defect is measured, a buccal mucosa graft is harvested in standard fashion. Two sutures are placed through the distal corners of the graft with the graft still outside the urethra, and the proximal end of the graft is then secured to the bladder neck using the RD 180 endoscopic suturing device. The proximal suture is cinched tight, pulling the graft to the bladder neck, and the distal end of the graft is pulled tight and flat along the defect using the two sutures attached to the distal graft. The graft is anchored to the posterior urethra using endoscopic Secure Straps. Once the graft is secure, a wire is passed into the bladder under direct visualization and a catheter is passed over wire to hold the graft flat during the subsequent 4 weeks. RESULTS: The procedure lasted 2.5 hours without any complications. Estimated blood loss was 50cc. Following the procedure, the patient was discharged home with a catheter in place. Catheter was removed at 4 weeks. At 10 weeks post-op, cystoscopy showed good graft viability, and peak flow was 20 ml/sec compared to 4 ml/sec pre-operatively. At six months, he continues to do well without evidence of recurrent urethral stricture. CONCLUSIONS: Endoscopic urethroplasty using buccal graft appears to offer a safe and effective repair option that could be considered for management of ureteral strictures. Source of Funding: none to report © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e751 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Garrett Ungerer More articles by this author Jayson Kemble More articles by this author Jonathan Warner More articles by this author Expand All Advertisement PDF downloadLoading ...