Anstomotic urethroplasty

Anastomotic Urethroplasty is a surgical procedure used to treat urethral strictures, which are narrowings or blockages of the urethra caused by scar tissue. This procedure involves excising the scarred segment of the urethra and reconnecting the healthy ends (anastomosis), effectively restoring normal urine flow. It is considered the gold standard for short-segment strictures, particularly in the bulbar urethra.

Indications

Anastomotic urethroplasty is recommended for:

1. Short Urethral Strictures:
   • Typically less than 2 cm in length.
   • Most often located in the bulbar urethra.
2. Traumatic Urethral Injury:
   • Strictures caused by blunt trauma or pelvic fractures.
3. Recurrent Strictures:
   • After failed minimally invasive procedures like dilation or urethrotomy.
4. Congenital Urethral Defects:
   • Rarely, for congenital narrowing of the urethra.

Preoperative Preparation

1. Diagnostic Workup:

   • Retrograde Urethrogram (RUG): To assess the location and length of the stricture.
   • Voiding Cystourethrogram (VCUG): For functional evaluation of the urethra.
   • Urethroscopy: Direct visualization of the stricture.
   • Urinalysis: To rule out infection.
   • Blood Tests: To assess general health and readiness for surgery.

2. Patient Counseling:

   • Discussion of the surgical procedure, risks, expected outcomes, and recovery timeline.

3. Anesthesia:

   • General or spinal anesthesia is typically used during the procedure.

Surgical Procedure

1. Positioning:

   • The patient is placed in a lithotomy position for optimal surgical access.

2. Incision and Exposure:

   • A small incision is made in the perineum (the area between the scrotum and anus).
   • The urethra is carefully exposed.

3. Stricture Excision:

   • The scarred section of the urethra is completely excised, ensuring all diseased tissue is removed.

4. Anastomosis:

   • The healthy proximal and distal ends of the urethra are mobilized and sutured together using fine, absorbable stitches to create a tension-free anastomosis.

5. Catheter Placement:

   • A urinary catheter is inserted to allow urine drainage and support the repair during the healing process.

6. Closure:

   • The incision is closed in layers, and a drain may be placed if necessary.

Postoperative Care

1. Hospital Stay:

   • Patients typically stay in the hospital for 1-3 days for monitoring.

2. Catheter Management:

   • The catheter remains in place for 2-3 weeks to allow the urethral repair to heal.
   • A follow-up urethrogram is performed before catheter removal to ensure the repair is intact.

3. Pain Management:

   • Analgesics are provided to manage postoperative discomfort.

4. Activity Restrictions:

   • Avoid heavy lifting, strenuous activity, and sexual intercourse for at least 4-6 weeks post-surgery.

Benefits

• High success rates (over 90%) for short-segment strictures.
• Permanent resolution of the stricture in most cases.
• Restoration of normal urinary flow.