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Augmented Anastomotic Urethroplasty

  • Chapter
Urethral Reconstructive Surgery

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

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Summary

Primary anastomotic urethroplasty with complete stricture excision provides for the most successful outcome in bulbar urethral reconstruction. For strictures too long to allow for a tension free anastomosis a substitution urethroplasty is often used. The augmented anastomotic urethroplasty is a combination repair that incorporates the principles of excision and substitution urethroplasty and is primarily used for those bulbar strictures deemed too long for straight forward primary anastomosis. In this repair, up to two centimeters of afflicted urethra is excised, and the ventral urethra is reapproximated and a buccal graft is applied dorsally, thus augmenting the anastomosis and addressing any adjacent wide-caliber stricture.

An evolution in graft use has led to our current exclusive use of buccal mucosa placed in a dorsal location. We also spread fix the graft to the overlying corporal bodies which securely applies the graft to its bed and reduces graft shrinkage and sacculation.

When the entire stricture cannot be excised we advocate removing the worst portion (up to two centimeters) a technique we term the ‘complex’ augmented anastomotic urethroplasty. We do still use pure onlay repairs but in less common scenarios.

In this chapter we discuss our graded approach to the management of bulbar strictures as well as our rationale for utilizing the augmented anastomotic repair. In addition our surgical technique is described.

We believe that by incorporating the benefits of primary anastomosis with dorsal buccal graft augmentation, the augmented anastomotic urethroplasty provides patients with a durable repair.

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References

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Author information

Authors and Affiliations

  1. Division of Urology, University of Medicine and Dentistry of New Jersey — New Jersey Medical School, Newark, NJ, USA

    Neil D. Sherman MD

  2. Division of Urology, Duke University School of Medicine, Durham, NC, USA

    George D. Webster MB, FRCS

Authors
  1. Neil D. Sherman MD
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  2. George D. Webster MB, FRCS
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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 GD Webster

1.1.1 Instruments

Jordan retractor system (C&S Surgical, Slidell, LA) for Bookwalter retractor system (Codman, Raynam, MA)

  • Wagenstein forceps

  • Flexible self-retaining retractor

  • Turner-Warwick needle driver

1.1.2 Suture

  • 5-0 polyglycolic acid suture for donor site closure

  • 5-0 polyglycolic acid suture for anastomosis

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

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Sherman, N.D., Webster, G.D. (2008). Augmented Anastomotic Urethroplasty. In: Brandes, S.B. (eds) Urethral Reconstructive Surgery. Current Clinical Urology. Humana Press. https://doi.org/10.1007/978-1-59745-103-1_13

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  • DOI: https://doi.org/10.1007/978-1-59745-103-1_13

  • 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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