In adults, urethral strictures from instrumentation trauma may occur after prostate surgery and urinary catheterization. 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. 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. Urethroplasty is a surgery where the urethra is reconstructed to cure problems like urethral strictures. Patients with urethral strictures most often present with obstructive voiding symptoms or urinary tract infections, such as prostatitis or epididymitis. Complications following reconstructive surgery for urethral stricture disease were mostly related to infection or repair breakdown in the immediate. Current controversies in reconstructive surgery of the anterior. Urethral stricture guideline american urological association. Pdf advanced male urethral and genital reconstructive. You are being provided with written instructions and information that addresses common questions and concerns. Obstructive voiding, urinary incontinence, or sexual dysfunction can resist behavioral and pharmaceutical therapies, and yet, fellowshiptrained surgeons who can manage.
Urethroplasty is the repair of an injury or defect within the walls of the urethra. The use of flaps in urethral reconstructive surgery. 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. 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. Complications following urethral reconstructive surgery. The urethra is the tube that carries urine out of the body from the bladder through the penis. Total bladder and posterior urethral reconstruction.
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. Reconstructive procedures performed on and around the. Urethral reconstructive surgery by pansypaquette issuu. Urethral stricturesresult in lower urinarytract symptomsand affect quality of life. 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. Current controversies in reconstructive surgery of the. Listing a study does not mean it has been evaluated by the u. The use of uroflowmetry to diagnose recurrent stricture after urethral reconstructive surgery. A reconstructive surgeon with lifechanging solutions genitourinary reconstructive surgery genitourinary reconstructive surgery can o. Most surgeries take between three to six hours to complete. Urethroplasty is regarded as the gold standard treatment for urethral strictures and offers better outcomes in terms of recurrence rates than. Enlightening urologists in a practical manner, urethral reconstructive surgery evaluates and manages complex urethral problems.
On close inquiry, many of these patients have tolerated obstructive voiding symptoms for prolonged periods before progressing to complete obstruction. It is usually reserved for strictures that are severe or nonresponsive to endoscopic management. 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. Urethral stricture evaluation and surgical management accessed 7222017. Written by a panel of experts in the field, urethral reconstructive surgery offers the anatomy of the urethra and the aspects of wound. Complex urethral vaginal surgery is performed to restore function and appearance to a sensitive and complicated region of the urethral and vaginal anatomy. Male urethral stricture american urological association. To evaluate the effect of urethral reconstructive surgery on sexual drive, erectile function and ejaculation. In children, urethral strictures most often follow reconstructive surgery for congenital abnormalities of the penis and urethra, cystoscopy and occasionally may be congenital. One of the more common reasons for reconstruction of the urethra. 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.
Erectile function, sexual drive, and ejaculatory function. Urethral reconstructive surgery can often be complex, time consuming and demanding. Reconstructive surgery and trauma reconstructive urethral surgery which are currently. The surgery is most often performed for urethral stricture or narrowing after trauma, such as a pelvic fracture. We present two case reports of patients with recurrent stricture of the urethra. Sep 21, 20 what are the causes for urethral stricture. An incision is made over the area of the stricture in the penis, scrotum, or. Surgical services include, but are not limited to, preoperative preparation, operating room services, recovery room services, and outpatient admitting and discharge. The whole field is described by authors who are world authorities in their respective areas of expertise. The surgery is most often performed for urethral stricture or. Various surgical techniques are currently being used to repair anterior urethral strictures with the goal of reducing morbidity and obtain ing the best outcome. Written by a panel of experts in the field, urethral reconstructive surgery offers the. Because men have a much longer urethra than women, it is more common for men to experience urethral damage requiring surgery.
This textbook seeks to determine the current stateoftheart of reconstructive urethral surgery and to identify new trends in this subspecialty of reconstructive urology. Pdf not all male voiding problems are due to the prostate and one will eventually meet a patient with various urethral conditions including. Pdf decision making and surgical technique in urethroplasty. 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. Posterior urethral reconstruction is a surgical procedure for males that is sometimes needed after trauma to the urethra.
Impact on sexual function after reconstructive surgery for. Urethral strictures occur in the majority of cases. Center for reconstructive urethral surgery center for reconstructive urethral surgery arezzo italy. This limit should be approximately 75% of the maximal constant traction length or a gaptonormal urethra ratio of 1. A reconstructive surgeon with lifechanging solutions. To improve outcome in adult patients, reconstructive surgeons have learned to apply the principles of hypospadias surgery, such as delicate tissue. The indiana health coverage programs ihcp defines surgical services as services for a member requiring or seeking medically necessary perioperative care. Historically, urethral dilation has been a preferred treatment choice for these patients. Aug 19, 2016 historically, urethral dilation has been a preferred treatment choice for these patients. Reconstruction of the urethra with a surgisis onlay patch. 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. The results of our research were divided according to different topics regarding reconstructive urethral surgery which are currently.
Pdf there is no technique which can be used in all types and localizations of urethral strictures. Reconstructive urethral surgery free download as pdf file. However, age related variations should be considered. We present an overview of fus and a summary of surgical management options. Reconstructive urethral surgery condition at yale medicine. 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. To apply flap technology to urethral reconstruction, the surgeon should have an excellent working knowledge of the vascular anatomy of the areas to be.
A variety of reconstructive surgical techniques have been described in recent years to provide more definitive management in this challenging group of patients. A layered closure in this manner provides reconstruction, and it avoids overlying suture lines, which may increase the chance of fistula formation. Since the publication of the first edition of urethral reconstructive surgery. Functional outcome of urethral reconstructive surgery full. Urethral extensibility applied to reconstructive surgery. 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. The primary function of the varied surgical procedures is to correct defects or damage to allow the patient to enjoy a healthy, full life.
The types of surgeries are varied and depend upon the location, cause, and length of the stricture. Urethral reconstructive surgery current clinical urology. Advanced male urethral and genital reconstructive surgery. Redo repairs to treat urethral stricture surgery complications are often very complex, and reconstructive surgical options are often more limited. Few urologists perform these procedures as training in them is hard to come by. Center for reconstructive urethral surgery arezzo italy. 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. Reconstruction male urethroplasty metrovan urology. Incidence, causes, and complications of urethral stricture.
Pdf advanced male urethral and genital reconstructive surgery. Perineal trauma, longterm urethral catheterisation, urologic instrumentation, chronic. The urethra is a small tubular structure that drains urine from the bladder. Since the publication of the first edition of urethral reconstructive surgery, important refinements have been added to the urologic surgical armamentarium. Urethral stricture is a common urologic disease affecting men. However, there are few major studies specifically analyzing complications following or during urethral reconstruction surgery. Changes in uroflowmetry maximum flow rates after urethral reconstructive surgery as a means to predict for stricture recurrence. The study group consisted of 150 men with a median range age of 40 1873 years who underwent 168 urethral reconstructive procedures.
Reconstructive surgery of the anterior urethra by j. This textbook covers urethral surgery up to the most recent developments. Reconstructive urethral surgery urology urinary incontinence. Reconstructive surgery of the anterior urethra sciencedirect. 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 textbook seeks to determine the current stateoftheart of reconstructive urethral surgery and to identify new trends in this subspecialty of reconstructive. Trauma, iatrogenic injury and infections are the most common causes of urethral injurydefect requiring repair. Welcome to the center for reconstructive urethral surgery, the first worldwide center for the diagnosis and treatment of male urethral stricture diseases. 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. Functional outcome of urethral reconstructive surgery the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. We provide a standard of excellence ensuring the highest standards of care of our patients.
Surgical services include, but are not limited to, preoperative preparation, operating room services. Urethral reconstructive surgery, or urethroplasty, is the only definitive treatment option for urethral strictures. Guido barbagli centro di chirurgia ricostruttiva dell. 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. Reconstructive urethral surgery has been shown to be an effective treatment for urethral stricture disease with durable results 14. Knowledge of the safe anatomical limit of urethral extensibility applied to reconstructive surgery may avoid complications and the necessity for more complex techniques. Center for reconstructive urethral surgery the 41st annual congress of the egyptian urological association december 17, 2006 cairo egypt. Urethroplasty is regarded as the gold standard treatment for urethral strictures and offers better outcomes in terms of recurrence rates than dilatations and urethrotomies. As clearly evident in the literature, isolated and short. Tre atment options include dilation, urethrotomy and reconstructive surgical techniques 1. Posterior urethral reconstruction recovery and outlook. Definitive urethral reconstruction for pelvic fracture urethral injury pfui should be planned only.
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