Urethroplasty: Posterior urethroplasty for pelvic fracture urethral injury

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. 

In this video, our group demonstrates a posterior urethroplasty for treatment of pelvic fracture urethral injury. The technique involves excision of a large portion of fibrosis at the apex of the prostate and membranous urethra. This excision provides excellent exposure to the prostate apex, allowing stitches to be placed under direct vision and tied easily.

Twelve stitches are pre-placed like a clock face in the distal and proximal urethra, and the distal urethra is then “parachuted” down to the prostate apex. Posterior urethroplasty by this technique is very successful and can also be used in cases of radiation injury after prostate cancer treatment for bulbo-membranous strictures.

Dr. Hotaling: Dr. Myers clearly demonstrates the impressive mobilization of the urethra that can be achieved in order to facilitate a successful posterior urethroplasty. This mobilization is the key step in the surgery and, along with complete excision of the fibrotic tissue, is what enables him to achieve a successful outcome for this patient.

More urethroplasty videos

Bulbospongiosus sparing dorsal onlay bulbar urethroplasty

Excision and primary anastomosis anterior urethroplasty

Perineal urethrostomy for severe urethral strictures

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