Urethral stricture is a common urologic disease affecting men. Since the publication of the first edition of urethral reconstructive surgery. The primary function of the varied surgical procedures is to correct defects or damage to allow the patient to enjoy a healthy, full life. Urethral reconstructive surgery can often be complex, time consuming and demanding. Trauma, iatrogenic injury and infections are the most common causes of urethral injurydefect requiring repair. However, age related variations should be considered. Complications following urethral reconstructive surgery. Surgical services include, but are not limited to, preoperative preparation, operating room services. Written by a panel of experts in the field, urethral reconstructive surgery offers the anatomy of the urethra and the aspects of wound healing and applicable plastic surgical techniques. Urethral injury may be of secondary importance when the patient comes into the emergency room, but devastating urological complications, such as sexual dysfunction, incontinence, and stricture, may drastically impair quality of life in the long term. The surgery is most often performed for urethral stricture or narrowing after trauma, such as a pelvic fracture. Center for reconstructive urology urethral reconstruction postoperative instructions following urethral reconstruction, your attention to proper postoperative followup will contribute to the success of your surgery.
Few urologists perform these procedures as training in them is hard to come by. You are being provided with written instructions and information that addresses common questions and concerns. Guido barbagli centro di chirurgia ricostruttiva dell. Urethral reconstructive surgery current clinical urology. Urethral reconstructive surgery, or urethroplasty, is the only definitive treatment option for urethral strictures. Because men have a much longer urethra than women, it is more common for men to experience urethral damage requiring surgery. Center for reconstructive urethral surgery, arezzo, italy keywords bulbar urethra, onestage repair oral, mucosa, free graft, sparing technique introduction the current surgical approach to the uncomplicated bulbar urethral stricture began in 1993 when elkasaby et al 1. Knowledge of the safe anatomical limit of urethral extensibility applied to reconstructive surgery may avoid complications and the necessity for more complex techniques. The types of surgeries are varied and depend upon the location, cause, and length of the stricture. Complications following reconstructive surgery for urethral stricture disease were mostly related to infection or repair breakdown in the immediate. This limit should be approximately 75% of the maximal constant traction length or a gaptonormal urethra ratio of 1. Pdf decision making and surgical technique in urethroplasty.
To this end, inter tionally known experts and opinion leaders in the field were invited to hamburg, germany to discuss and demonstrate todays commonly used surgical. Pdf advanced male urethral and genital reconstructive. In these two case reports, we show the positive results of reconstructive surgery with surgisis as an alternative surgical approach to common onlay patch surgery of the urethra performed on two caucasian patients. Pdf not all male voiding problems are due to the prostate and one will eventually meet a patient with various urethral conditions including. We provide a standard of excellence ensuring the highest standards of care of our patients. The success of open urethroplasty is extremely dependent on the surgical technique and the expertise of the surgeon, making it essential to only undergo surgery at a urology center that is dedicated. Aug 19, 2016 historically, urethral dilation has been a preferred treatment choice for these patients. Posterior urethral reconstruction recovery and outlook. Pdf there is no technique which can be used in all types and localizations of urethral strictures. The urethra is the tube that carries urine out of the body from the bladder through the penis. Urethral stricture evaluation and surgical management accessed 7222017. Urethral reconstructive surgery by pansypaquette issuu.
Functional outcome of urethral reconstructive surgery the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Most surgeries take between three to six hours to complete. The study group consisted of 150 men with a median range age of 40 1873 years who underwent 168 urethral reconstructive procedures for anterior urethral stricture disease between october 2003 and may 2009. Listing a study does not mean it has been evaluated by the u. Functional outcome of urethral reconstructive surgery. The use of flaps in urethral reconstructive surgery.
Success rates with repairs of urethral strictures from pelvic fractures is about 90%98% with excision of the stricture and bringing the ends of the urethra together reapproximation. This realignment of the urethra decreases the risk of urethral stricture formation by about 30% and makes surgery for repair of the stricture, if it occurs, easier. Center for reconstructive urethral surgery the 41st annual congress of the egyptian urological association december 17, 2006 cairo egypt. Male urethral stricture american urological association. Reconstruction male urethroplasty metrovan urology. Reconstructive procedures performed on and around the. Advanced male urethral and genital reconstructive surgery. Reconstructive surgery of the anterior urethra by j. The results of our research were divided according to different topics regarding reconstructive urethral surgery which are currently. We present an overview of fus and a summary of surgical management options. Complex urethral vaginal surgery is performed to restore function and appearance to a sensitive and complicated region of the urethral and vaginal anatomy. Although the urethral injury is seldom the main problem of these often severally and severely traumatized patients, consequences of the urethral trauma such as urethral strictures, erectile dysfunction, and in some cases urinary incontinence may be problems with lifelong ramifications for these patients. Surgical services include, but are not limited to, preoperative preparation, operating room services, recovery room services, and outpatient admitting and discharge.
Urethral extensibility applied to reconstructive surgery. One of the more common reasons for reconstruction of the urethra. Welcome to the center for reconstructive urethral surgery, the first worldwide center for the diagnosis and treatment of male urethral stricture diseases. Reconstructive urethral surgery free download as pdf file. Urethral stricture guideline american urological association. It is usually reserved for strictures that are severe or nonresponsive to endoscopic management. Written by a panel of experts in the field, urethral reconstructive surgery offers the anatomy of the urethra and the aspects of wound. Pdf advanced male urethral and genital reconstructive surgery. Impact on sexual function after reconstructive surgery for. Since the publication of the first edition of urethral reconstructive surgery, important refinements have been added to the urologic surgical armamentarium. Sep 21, 20 what are the causes for urethral stricture. A reconstructive surgeon with lifechanging solutions genitourinary reconstructive surgery genitourinary reconstructive surgery can o. Urethroplasty is regarded as the gold standard treatment for urethral strictures and offers better outcomes in terms of recurrence rates than dilatations and urethrotomies.
On close inquiry, many of these patients have tolerated obstructive voiding symptoms for prolonged periods before progressing to complete obstruction. Functional outcome of urethral reconstructive surgery full. Definitive urethral reconstruction for pelvic fracture urethral injury pfui should be planned only. Changes in uroflowmetry maximum flow rates after urethral reconstructive surgery as a means to predict for stricture recurrence. Center for reconstructive urethral surgery center for reconstructive urethral surgery arezzo italy. A layered closure in this manner provides reconstruction, and it avoids overlying suture lines, which may increase the chance of fistula formation. Enlightening urologists in a practical manner, urethral reconstructive surgery evaluates and manages complex urethral problems. Extensively revised and updated, advanced male urethral and genital reconstructive surgery, second edition guides urologists in a practical manner on how to evaluate and manage complex urethral and male genital reconstructive challenges. In adults, urethral strictures from instrumentation trauma may occur after prostate surgery and urinary catheterization. Patients with urethral strictures most often present with obstructive voiding symptoms or urinary tract infections, such as prostatitis or epididymitis. Nov, 20 functional outcome of urethral reconstructive surgery the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. This textbook seeks to determine the current stateoftheart of reconstructive urethral surgery and to identify new trends in this subspecialty of reconstructive urology. Once the urethral closure is performed, the previously mobilized pubocervical fascia is closed in layers vestoverpants with 20 vicryl suture over the urethral repair fig.
Urethroplasty is the repair of an injury or defect within the walls of the urethra. To evaluate the effect of urethral reconstructive surgery on sexual drive, erectile function and ejaculation. A variety of reconstructive surgical techniques have been described in recent years to provide more definitive management in this challenging group of patients. The indiana health coverage programs ihcp defines surgical services as services for a member requiring or seeking medically necessary perioperative care. In children, urethral strictures most often follow reconstructive surgery for congenital abnormalities of the penis and urethra, cystoscopy and occasionally may be congenital. Total bladder and posterior urethral reconstruction. Reconstructive surgery of the anterior urethra sciencedirect. Perineal trauma, longterm urethral catheterisation, urologic instrumentation, chronic.
Center for reconstructive urethral surgery arezzo italy. The use of uroflowmetry to diagnose recurrent stricture after urethral reconstructive surgery. Written by a panel of experts in the field, urethral reconstructive surgery offers the. Urethroplasty is regarded as the gold standard treatment for urethral strictures and offers better outcomes in terms of recurrence rates than. Reconstruction of the urethra with a surgisis onlay patch. This textbook covers urethral surgery up to the most recent developments. Patients and methods the study group consisted of 52 men with a median range age of 44 1879 years who underwent 59 urethral reconstructive procedures for anterior urethral stricture disease between 2001 and 2004. An incision is made over the area of the stricture in the penis, scrotum, or. The precipitating condition is often stricture, a urinary blockage that occurs when trauma, inflammation or frequent urinary tract infections lead to a narrowing of one portion of the urethra, causing painful and obstructed urination. Posterior urethral reconstruction is a surgical procedure for males that is sometimes needed after trauma to the urethra. Urethroplasty is a surgery where the urethra is reconstructed to cure problems like urethral strictures. Erectile function, sexual drive, and ejaculatory function.
To improve outcome in adult patients, reconstructive surgeons have learned to apply the principles of hypospadias surgery, such as delicate tissue. To apply flap technology to urethral reconstruction, the surgeon should have an excellent working knowledge of the vascular anatomy of the areas to be. This textbook seeks to determine the current stateoftheart of reconstructive urethral surgery and to identify new trends in this subspecialty of reconstructive. Current controversies in reconstructive surgery of the anterior. Reconstructive urethral surgery urology urinary incontinence. The whole field is described by authors who are world authorities in their respective areas of expertise. Urethral stricturesresult in lower urinarytract symptomsand affect quality of life. Reconstructive surgery and trauma reconstructive urethral surgery which are currently. Historically, urethral dilation has been a preferred treatment choice for these patients.
Current controversies in reconstructive surgery of the. Urethral strictures occur in the majority of cases. However, there are few major studies specifically analyzing complications following or during urethral reconstruction surgery. The urethra is a small tubular structure that drains urine from the bladder. Reconstructive urethral surgery condition at yale medicine. A reconstructive surgeon with lifechanging solutions. The study group consisted of 150 men with a median range age of 40 1873 years who underwent 168 urethral reconstructive procedures. We present two case reports of patients with recurrent stricture of the urethra. Various surgical techniques are currently being used to repair anterior urethral strictures with the goal of reducing morbidity and obtain ing the best outcome. Reconstructive urethral surgery has been shown to be an effective treatment for urethral stricture disease with durable results 14.
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