Urethroplasty: Bulbospongiosus sparing dorsal onlay bulbar urethroplasty

Author(s):

This video demonstrates buccal mucosa graft urethroplasty for lengthy bulbar urethral strictures that are not amenable to excision and primary anastomotic urethroplasty.

Section Editor’s note: ‘Y’tube, a new video section of UrologyTimes.com, is a resource for urologists and other clinicians who focus on men’s health. ‘Y’tube covers surgical aspects of a variety of men’s health issues with the ultimate goal of accumulating a library of videos to serve as a reference. Here, three reconstructive urologists fellowship trained by Jack McAninch, MD, or Hunter Wessells, MD, illustrate the nuances of managing urethral stricture disease. Perhaps the most important aspects of these videos for the general urologist are the keys of precise setup, retraction, and exposure that facilitate meticulous tissue handling and precise suture placement. These videos serve as a reference that can be quickly reviewed before undertaking any of these procedures.

This video demonstrates buccal mucosa graft urethroplasty for lengthy bulbar urethral strictures that are not amenable to excision and primary anastomotic urethroplasty. In addition, the video emphasizes sparing of the bubospongiosus muscle rather than division of the muscle.

Dr. Myers: Dr. Vanni shows the release of the bulbospongiosus muscle from the bulbar urethra and around the inferior aspect of the bulb, with gentle retraction of the muscle rather than midline division of the muscle. Although the evidence does not strongly support of an effect, proponents of this technique believe it decreases problems with post-void dribbling and ejaculatory dysfunction by preserving the function of the bulbospongiosus muscle. Despite natural worries about limiting exposure to the deep bulbar urethra, Dr. Vanni clearly demonstrates excellent exposure right up to the start of the membranous urethra.

Another nice part of the video is Dr. Vanni’s use of a Gorget retractor to place stitches at the proximal urethral spatulation. The placement of sutures at the level of the bulbo-membranous junction can be very challenging and, as show in the video, this task can be facilitated by a retractor like the Gorget.

Dr. Hotaling: Dr. Vanni illustrates the use of many of the nuanced tools and techniques that facilitate atraumatic tissue handling and exposure in reconstructive urology. He also illustrates how an atraumatic exposure of the entire bulbar urethra can be achieved without the need for complete division of the bulbospongiosus muscle. His meticulous tissue handling and excellent exposure allow for a precise anastomosis.