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Beitragstitel Anastomotic Urethral Reconstruction of a Traumatic Fall-astride Urethral Stricture after TURP – Troubleshooting, Tips&Tricks on How to Achieve a Successful Repair
Beitragscode V001
Autor:innen
  1. Mustafa Tutal Kantonsspital Winterthur Präsentierende:r
  2. Hubert John Kantonsspital Winterthur
  3. Daniela Andrich 2University College London Hospitals NHS Foundation Trust, London, United Kingdom
Präsentationsform Freie Mitteilungen
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Abstract-Text Introduction: Traumatic fall-astride urethral injuries pose a number of surgical challenges due to urethral tissue loss and soft tissue plane distortion. The identification of the proximal end, which is embedded in dense scar tissue, can be unpredictable and difficult. Simple maneuvers such as ‘cutting-to-the-light’ using a cystoscope do not work because the light does not shine through the dense scar tissue. The length of the stricture (i.e. severity of urethral segment loss) can’t be changed and auxiliary surgical maneuvers may be necessary to achieve a tension-free anastomosis for successful repair.
Methods: We demonstrate the entire urethroplasty of a 77 year man after prior TURP who had perineal trauma causing a 4 cm unusually proximal bulbar stricture close to the intact external urethral sphincter. Results: This video shows frequently encountered challenges of urethral reconstruction for traumatic urethral strictures. After full urethral mobilization, localization of the proximal end was challenging in this case. We demonstrate suprapubic cystoscopy controlled perineal placement of a spinal needle through the scar into the prostatic urethra to safely guide the scalpel into the correct direction. After completion of the parachuted anastomosis, placement of the urethral catheter was not possible. We demonstrate that failed catheterization was solved without delay by using the novel Urethrotech UCD® which guides the catheter via integrated guidewire safely into the bladder. The patient made an uneventful recovery and the urethral catheter was removed after two weeks after the peri-catheter urethrogram confirmed a well healed and patent anastomosis without leak. The patient voided to completion and is continent since catheter removal.
Summary:Urethral reconstruction for traumatic strictures can be challenging. Successful urethral reconstruction demands high level intra-operative decision making and technical expertise. Perineal placement of a spinal needle through the scar into the prostatic urethra under suprapubic cystoscopic control guides the needle and then scalpel safely into the correct direction. This is a helpful maneuver to avoid serious surgical error. Failed insertion of the urethral catheter after completion of the anastomosis can be safely managed without the risk of disruption of the repair by guiding the catheter into the bladder with a hydrophilic Nitinol guidewire again avoiding serious surgical error.