DR. MAYANK MOHAN AGARWAL
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Anastomotic urethroplasty

In this single-stage procedure, the urethra will be foreseen (in the area of the defect), and the incision will be made at its mid-line (usually) using a bovie knife to dissect the dermal and sub-dermal layers until the associated musculature, corpus cavernosum, corpus spongiosum, and ventral urethral aspects are exposed.

Particular care is used during the dissection to avoid damage to nerves and blood vessels (which could result in erectile dysfunction or loss of tactile sensation of the penis). The area of the defect is assessed and mark both mid-line (laterally), and at the distal and proximal borders (transversely).

Marked/labeled positioning sutures are secured at the proximal and distal ends of the mid-line area of urethra closest to the bisection points. Using an index finger, the urethra is gently separated from the cavernosum, and a specially designed retractor can be then placed behind the urethra to protect vulnerable areas from damage during the transecting and removal of the urethral defect. The now patent ends of the urethra is prepared using a technique called "spatulation", which (essentially) allows for the end-to-end anastomosis to adjust to the differing diameters of the urethra. A silicone catheter is placed through the penis and (temporary) distal-urethral end, and threaded into the (temporary) proximal-urethral end, leaving a wide loop for the surgeon to have access to the dorsal urethral aspect for micro-suturing, and start of the anastomosis. The dorsal one-third of the urethral anastomosis is started, completed, and the catheter is retracted slightly to enable for its positioning within the pre-anastomosed urethra.

At this time, using micro surgical technique, the anastomosis is completed and fibrin glue is applied to the anastomotic suture line to help avoid leakage and fistula formation. The silicone guide catheter can then be withdrawn from the penis and (a) replaced by an appropriately sized Foley catheter (and urinary drainage system), and the cut closed (layer by layer).

Some surgeons will inject a local anesthetic such as 2% plain lidocaine or 0.5% bupivicaine into the areas to enable the patient an additional period of relief from discomfort.

Micro-doppler circulatory measurement of the penile vasculature is done at way points throughout the procedure, and a final assessment is taken and recorded. The cut/incision is inspected and dressed, and the patient is discharged to recovery.