Urethroplasty: Excision and primary anastomosis anterior 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 one of the most simple and reliable urethroplasty techniques: excision and primary anastomosis of the urethra. Anastomotic urethroplasty has a greater than 90% clinical success in most studies and works well in almost all of the bulbar urethra for limited strictures of <2.0 to 3.0 cm.

Dr. Myers: Key elements that are well demonstrated in Dr. Elliott’s video include achieving a high lithotomy position. This position can be achieved with extended candy cane stirrups, as shown, or with Allen-type stirrups with the legs extended almost straight before raising them into lithotomy. Another critical part of the surgery is full excision of all of the fibrotic urethral scar in order to avoid recurrent stricture.

Other aspects of successful anastomotic urethroplasty that the video demonstrates very well are aggressive mobilization of the urethra to allow a tension-free anastomosis, as well as the fine two-layer ventral closure of urethral mucosa followed by the adventitia of the corpora spongiosus.

Dr. Hotaling: Dr. Elliott demonstrates the nuances of one of the most durable repairs for urethral stricture disease. Specific points to highlight are the positioning of the patient, maintenance of a clear tissue plane that is directly in the midline, and atraumatic meticulous exposure to facilitate precise suture placement. All of these steps allow a tension-free two-layer anastomosis as well as precise reconstruction of the overlying tissue planes to facilitate healing of the anastomosis.

More urethroplasty videos

Bulbospongiosus sparing dorsal onlay bulbar urethroplasty

Perineal urethrostomy for severe urethral strictures

Posterior urethroplasty for pelvic fracture urethral injury

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