Stricture Penile Urethra

• 05 Jun 2020 12:51:24 PM
• |Reconstructive Urology

50 year patient has history of accidental pull out of foley urethral catheter with balloon inflated.

Comments(11)

• 

  Rahul Kapoor

  05 Jun 2020 01:03:35 PM

  I will plan a dorsal onlay urethroplasty. 

  In todays time, preputial skin will be first option if favourable

• 

  Tikenjit Mazumdar

  05 Jun 2020 01:19:18 PM

  I would like to add two more test sir,

  1/MCU want to know bladder neck status

  2/ urethrocystoscopy by 6 fr flexible urethrocystoscopy or by 7 fr ureteroscope...

  Want to classify it calibre as less then 6 fr or less than 3 fr..if less than 3 fr... multistage procedure... Johanson stage 1..ashopa stage 2.

  If..less than 6fr... would like to do dorsal only bmg...

• 

  Dr. Anil Takvani

  05 Jun 2020 01:32:19 PM

  @ Tikenjit,

  How will you insert flexible URS in stricturous penile urethra?

  Please just don't mention operation names, write your plan in detail.

• 

  Lalit Shah

  05 Jun 2020 01:47:44 PM

  Looks like a self inflected pan urethral stricture.

  Counselling , informed shared decision.

  Options

  1/-BMG pan urethroplasty,

  But at present during Covid time, I would prefer to avoid BMG, more so long segment at least for a month or two,

  If patient/attendants are understanding and willing, SPC to buy time.

  Before surgery urethroscopy with small URS would be helpful.

  If caliber more than 6-8 F at most part of length, single stage Kulkarni technique.

  Else lay open stage one, after 3-6 months stage two, BMG at stage two( not at stage one)

  2/- Though young, but still option of perineal urethrostomy would be explained.

  Many Indian patients from remote areas etc would prefer high a one time solution with high chances of success.

• 

  Tikenjit Mazumdar

  05 Jun 2020 01:47:47 PM

  Yes sir,we need to calibre te to classify .. endoscopic ly...if it's complete obliteration..no question of putting a endoscope..then..it needs stage procedure....but..I can see dye has gone in...some calibre is present...so need calibration by ureteroscope or small flexible scope to define caliber...it's will decide if stage procedure or single stage procedure.

• 

  Tikenjit Mazumdar

  05 Jun 2020 01:54:49 PM

  Somemore history will be helpful,urinary stream,straing urinary obstruction....creatine level...if anything..would advise him for SPC..

  Definate operation after 3 months .

  If passing urine per urethra...wolud like to add usg bladder for bladder wall thick ness n pvr .or upper track abnormalities..if anything...would advise him on SPC

• 

  Dr. Anil Takvani

  05 Jun 2020 04:20:36 PM

  RFT normal 

  No sepsis 

  Upper tracts normal, 165 cc PVR 

  Severe outflow obstructive symptoms. 

  
  

  @Lalit Sir,  thanks.

• 

  PANKAJ JOSHI

  05 Jun 2020 06:39:33 PM

  Agree with comments of Dr Lalit Shah 

  This is long stricture 

  Needs dorsal approach Kulkarni technique

  If someone was passing urine well and now poor flow , It’s most likely because of stricture in this patient 

  Buccal graft better than Preputial 

  
  

• 

  Dr. Anil Takvani

  05 Jun 2020 07:39:00 PM

  @ Dr. Pankaj,

  Have you started harvesting buccal mucosa for stricture urethroplasty?

  Whith what precausions?

  Thanks

• 

  Nitesh Jain

  05 Jun 2020 07:57:48 PM

  When was the catheter pulled out , I feel it’s important as would like to wait for 12 weeks before the inflammation settles 

  
  

  Dorsolateral onlay BMGU with penile invagination Will be my choice 

• 

  Dr. Anil Takvani

  05 Jun 2020 08:23:28 PM

  @Nitesh, 

  8 to 9 months before. 

  Why dorsolateral?

  Thanks