Video 2: 2nd stage Urethroplasty for distal Urethral BXO

Published Date: 23rd September 2023

Publication Authors: Pina IM, Floyd Jr MS

Introduction
2nd stage Urethroplasty involves tubularising the new urethral plate over a catheter, fashioning a new meatus and closing the distal urethra. Typically, this occurs 9 months after a 1st stage BUMG replacement.

Methods
Meatal apposition is assessed and distal urethral calibre gauged with a sound. The inner and outer urethral edges are marked encompassing the neomeatus. A ring block is injected and a tourniquet placed.

The neourethral edge and skin edge are incised with a bevelled blade and excised. The Urethral plate is carefully undermined along its length to the glans and stay sutures placed. A catheter is temporarily inserted to assess the meatus and urethral mobility. The meatus is then apposed with 5’0 vicryl and meatal patency gauged. A 12fr catheter is inserted and the urethral edges “rolled” and scarified with a blade. Closure occurs in 4 layers starting proximally. The urethra is closed extramucosally avoiding the graft plate. A catheter is placed and the urethral closure is completed up to the meatus followed by the spongiosum. The 3rd layer involves mobilising the superficial penile fascia and closing it over the spongiosum to avoid a fistula and ensuring a watertight closure. A glansplasty is next undertaken with transient glans compression to avoid a haematoma before closing the penile shaft skin. A compression dressing is applied with the catheter taped to the abdomen.

Results
After 2 weeks the patient returns for a TWOC.

Conclusion
The patient is assessed at 3 months with repeat symptom scores showing excellent symptom resolution.

 

Pina, IM; Floyd Jr, MS. (2023). 2nd stage Urethroplasty for distal Urethral BXO. European Urology Open Science. 55(Suppl 1), p.S27. [Online]. Available at: https://doi.org/10.1016/S2666-1683(23)00992-8 [Accessed 4 April 2024]

 

« Back