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Stricture Excision and Primary Anastomosis for Anterior Urethral Strictures

  • Chapter
Urethral Reconstructive Surgery

Part of the book series: Current Clinical Urology ((CCU))

  • 1674 Accesses

Summary

Stricture excision and primary end to end anastomosis is the best surgical treatment for anterior urethral strictures. After resecting all fibrotic urethral walls, proximal and distal urethral ends are mobilized so they can be approximated without tension to bridge the gap. Natural urethral elasticity is used to elongate the urethra and the distance can be shortened by opening the inter-crural septum. A wide mucosa-to-mucosa tension-free anastomosis is then performed using fine interrupted absorbable sutures. This procedure is ideally suited for bulbar strictures 1 –3 cm long, but it can also be successful in some selected cases with proximal bulbar strictures up to 5 cm in length. Because the anterior penile urethra is stretched during erection, this procedure is limited in the pendulous urethra, as it can produce shortening of the urethra and ventral curvature of the penis on erection. Complications are rare, mainly infection or hematoma of the operative wound. Sterile urine at the time of surgery and meticulous hemostasis are required to avoid them. Late failures are related to excessive tension at the anastomosis or incomplete fibrous resection. Complete excision of the fibrotic urethra is essential, and the surgeon must be prepared to perform an alternative form of repair if this resection results in a defect too long for a tension-free end to end reconstruction. When performed properly, excision and primary anastomosis is a well-tolerated, low-morbidity and highly effective procedure, with a long-term cure rate around 95 %.

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Author information

Authors and Affiliations

  1. Urology Service, Hospital del Trabajador, Santiago, Chile

    Reynaldo G. Gomez MD

Authors
  1. Reynaldo G. Gomez MD
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Editor information

Editors and Affiliations

  1. Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA

    Steven B. Brandes M.D., FACS

Appendix

Appendix

1.1 Preferred Instruments and Suture of RG Gomez

1.1.1 Instruments

Although I use pretty much standard surgical instruments for urethroplasty, I also use:

  • 2.5x magnifying loupes

  • Fiberoptic headlight

  • Bipolar cautery

  • DeBakey vascular forceps to handle the spongio-sum and urethra

  • Ball-point curved Potts scissors A long (6 cm) nasal speculum A rubber inter-molar retractor (for BM procurement)

  • I always use the Scott retractor. My favorites are the medium size (blue) hooks and the double (green) hooks.

1.1.2 Suture

As suture material, I almost always use 5/0 and 6/0 Monocryl

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© 2008 Humana Press, a part of Springer Science + Business Media, LLC

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Gomez, R.G. (2008). Stricture Excision and Primary Anastomosis for Anterior Urethral Strictures. In: Brandes, S.B. (eds) Urethral Reconstructive Surgery. Current Clinical Urology. Humana Press. https://doi.org/10.1007/978-1-59745-103-1_10

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  • DOI: https://doi.org/10.1007/978-1-59745-103-1_10

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-826-3

  • Online ISBN: 978-1-59745-103-1

  • eBook Packages: MedicineMedicine (R0)

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