Phalloplasty
James Barrett in Transsexual and Other Disorders of Gender Identity, 2017
Catheter management is the bane of patients’ lives. After urethroplasty, urethral catheters usually stay in for 1 or 2 weeks, depending on individual surgeons’ preferences. Catheters are necessary to act as stents to keep the neourethra patent. However, they become colonised with bacteria within 2 weeks, and can cause mechanical irritation to suture lines and hence fistulae. Accordingly they should only be in for the minimum length of time needed. Some surgeons insert additional suprapubic catheters to divert the urinary stream while the neo-urethra is healing. Because the neo-urethra often does not have urine flowing through it until the join-up urethroplasty, the distal urethra has a tendency to shrink from disuse. We advise our patients to dilate the distal urethra with a 16F or 18F catheter on a weekly basis until the join-up urethroplasty.
Case 2.16
Monica Fawzy in Plastic Surgery Vivas for the FRCS(Plast), 2023
How would you manage a urethral stricture?The first step is to diagnose it: the patient will present clinically with symptoms of frequency and repeated infections.Investigations include:ultrasound of the bladder and kidneys – with expected secondary hypertrophy of the bladder and renal cortical thinning in the case of a urethral stricture, andurine flowmetry – which is expected to show an abnormal flow rate curve and a residual volume due to the outflow obstruction.It is important to note that some patients will have mild obstruction visible on flowmetry but will be asymptomatic and these patients do not need an operation.Treatmentconsists initially of urethral dilation,but many will eventually require a urethroplasty.
Life Care Planning for Spinal Cord Injury
Roger O. Weed, Debra E. Berens in Life Care Planning and Case Management Handbook, 2018
At just over 13 months post-injury, Mr. Name's clinical presentation is consistent with C7 motor, T4 sensory AIS B tetraplegia. Further significant gains from additional physiologic recovery are not anticipated; therefore, his current clinical presentation represents permanent manifestations of his central neurologic injury. Consistent with his spinal cord injury, he has a neurogenic bowel and bladder, as well as erectile dysfunction and sexual dysfunction. Mr. Name is followed in the outpatient setting of the SCI Model System program where he continues to receive physical therapy three times weekly, occupational therapy twice weekly, and a gym-based quad exercise program with a personal trainer 2 days weekly. He is followed medically by his physiatrist, urologist, and primary care physician for SCI-related care. The status of his urethra is being followed closely by his urologist to determine if he will ultimately require urethroplasty. Despite catheterizations at five to six times daily, Mr. Name continues with high intravesical pressures and is undergoing intravesical botulinum toxin A injections via cystoscopy at 3- to 4-month intervals.
One-year follow-up after urethroplasty, with the focus on both lower urinary tract and erectile function
Published in Scandinavian Journal of Urology, 2020
David Míka, Jan Krhut, Kateřina Ryšánková, Radek Sýkora, Libor Luňáček, Peter Zvara
In the past, most USD cases were treated with urethral dilatations and/or internal urethrotomy. These methods are currently reserved for palliative care, while urethroplasty became the gold standard. This trend is evident, as the number of open urethroplasties performed in the United States increased more than 3-fold between 2004 and 2012 [3]. Urethroplasty is a safe surgical procedure with low incidence of perioperative morbidity and mortality [4]. Studies conducted at specialized centers with a sufficient volume of urethroplasty procedures report a success rate above 80% [5]. On the other hand, it must be recognized that a consensus on the definition of success in the US treatment is lacking. Previously, no need for re-treatment was accepted as a definition of success [6]. Today, most studies report success based on quantifiable functional outcome data obtained mostly from retrograde urethrography and uroflowmetry. The effect of urethral surgery on erectile function was first evaluated in a study by Mundy [7] published in 1993. Since then, only a limited number of studies focusing on this aspect of treatment have been published, yielding conflicting results [8].
Could the bulbar urethral end location on the cystourethrogram predict the outcome after posterior urethroplasty for pelvic fracture urethral injury?
Published in Arab Journal of Urology, 2023
Ahmed M. Harraz, Adel Nabeeh, Ramy Elbaz, Abdalla Abdelhamid, Mohamed Tharwat, Amr A. Elbakry, Ahmed S. El-Hefnawy, Ahmed El-Assmy, Ahmed Mosbah, Mohamed H. Zahran
Electronic records were available for 250 patients of whom 158 (196 urethroplasty procedures) had CUG images available and of adequate quality. The mean patients’ age and body mass index were 32.7 (14.2) years and 27.7 (8.1) Kg/m2, respectively. The procedure was done 2 times in 26 (16.5%) patients and 3 times in 6 (3.8%). Primary realignment was not done in any of our patients with all underwent suprapubic cystostomy at the time of urethral injury. The median (IQR) time to urethroplasty was 4 (3–6) months. Postoperatively, superficial wound infection occurred in 4 patients and required frequent dressing. Blood transfusion was required in 7 patients. The median (IQR) hospital stay was 6 days (5–9).
Application of amniotic membrane in reconstructive urology; the promising biomaterial worth further investigation
Published in Expert Opinion on Biological Therapy, 2019
Jan Adamowicz, Shane Van Breda, Dominik Tyloch, Marta Pokrywczynska, Tomasz Drewa
Apart from bladder reconstruction, AM was tested as a replacement for urethra and ureter wall. Due to a diffused vascular bed which might be unintentionally damaged during reconstructive surgery, urethra and ureter are prone to chronic ischemia related fibrosis. Shakir et al. proposed using patches from xenogenic AM to prevent fibrotic reactions after urethroplasty when using rabbits as a model [125]. AM acted as a biologically active barrier, which supplemented the injury site with growth factors and inhibited fibrosis. Authors recommended this approach as a promising inexpensive way to improve urethroplasty results.
Related Knowledge Centers
- Mucous Membrane
- Urethrotomy
- Urethra
- Major Trauma
- Medical Error
- Urethral Stricture
- Surgical Anastomosis
- Graft
- Operating Theater
- Nothing By Mouth