General Technical Considerations and Decision Making in Urethroplasty Surgery

Summary

General technical skills for urethro-plasty surgery can often be learned fairly quickly by the trainee. The difficult skill to acquire, which often times requires years of experience, is the ability to make proper and sound, pre and intraop-erative decision making. Here-in we have detailed how to properly and accurately evaluate ure-thral strictures by imaging, cystourethroscopy and physical examination. Operative tricks and tips, as to patient selection, timing of surgery, patient positioning and surgical technique specifics are elaborated. Key aspects of anterior and posterior urethroplasty surgical methods are detailed, in particular, the methods of excision and primary anastomosis, buccal mucosal grafting, and penile skin flaps.

Appendix

1.1 Preferred Instruments of SB Brandes

1.2 Instruments

• 1. Yellowfin stirrups

• 2. 3M-irrigation pouch, “Steri-drape” ♯1016. Suction tubing to bottom of pouch

• 3. Bipolar, “bayonet”, wide tip cautery

• 4. Baby Yankauer-type suction, “Andrews” sucker

• 5. Bougie a boules from 10F to 32F

• 6. Lonestar retractor, ♯3308 (large ring) and corresponding hook: Blue (“dura”) hooks, ♯3311 (5mm) × 6, and Four-arm yellow hooks , ♯3334 (14 × 20mm) × 4 (Cooper Surgical , Trumbel, CT)

• 7. 20F Robnel catheter

• 8. Stevens Tenotomy scissors, 6„

• 9. 0.5 Castro toothed forceps × 2

• 10. Jerold's forceps with teeth × 2

• 11. Van Buren sounds 20F-32F

• 12. Steinhauser mouth retractor/mucosal stretcher (Walter Lorenz Surgical Instruments, #01-0060)

• 13. Foam pad from needle counter or Vein board

1.3 Suture

• 1. 2-0 Prolene (polypropylene), SH needle, tapered × 1 (for glans penis traction or vermillion of mouth)

• 2. 4-0 chromic, RB-1, tapered

• 3. 4-0 PDS, tapered, single armed, RB-1

• 4. 16F Silastic Foley, 5cc balloon

• 5. 2-0 Vicryl (polyglactin), SH needle, tapered, 3-0 Vicryl (polyglactin) , SH needle, tapered, 3-0 chromic, SH needle, tapered