Stricture urethra

• 13 Mar 2020 10:52:04 AM
• |Reconstructive Urology

This 42 years male undergone bmg urethroplasty in 2012 for bulbar urthral stricture(as per his reports).He undergone dviu in 2013,2014,2015,2016,2018,now in January 2020 he presented to us  with acute urinary retention for which we have done spc.recent Aug attached.how to manage this case?

Comments(15)

• 

  Tikenjit Mazumdar

  13 Mar 2020 11:17:17 AM

  He was on irregular self dilatation regime.

• 

  Jaideep Mahajani

  13 Mar 2020 01:03:52 PM

  It is essential to delineate proximal bulbar urethra. Need better contrast study if you want to revise urethroplasty. 

  Thanks 

• 

  Ashish parikh

  13 Mar 2020 04:43:33 PM

  Repeat RGU + MCU

  Is there any BXO changes?

  Any erectile dysfunction?

• 

  Tikenjit Mazumdar

  13 Mar 2020 09:15:03 PM

  I will try to get these investigation done...thank u sir..no bxo changes..no ED

• 

  PANKAJ JOSHI

  16 Mar 2020 12:28:27 PM

  Dear Dr Tikenjit

  The history clearly suggests a Failed Urethroplasty 

  Multiple VIU 

  Patient Merits a redo Urethroplasty 

  This is a long stricture 

  Irrespective of latetest imaging ,dorsal approach may be needed

  Need to look at the obliterated segment on MCU 

  
  

• 

  Tikenjit Mazumdar

  16 Mar 2020 01:18:33 PM

  Thank u sir...my question is what is success rate for such multiple viu? should redo urethroplasty done after 2nd viu failure?now should we do stage procedure for this case?

  I will post mcu picture once patient come back..thank u sir

• 

  Rahul Kapoor

  16 Mar 2020 09:00:02 PM

  Hi

  ASU is not properly delineating complete stricture length. Its obvious its long segment. 

  Plan is to do redo BMG urethroplasty. 

  Will MCU change the plan an anyway ? 

  
  

• 

  Tikenjit Mazumdar

  17 Mar 2020 12:49:12 PM

  MCU and AUG

  

• 

  Lalit Shah

  17 Mar 2020 01:50:08 PM

  It’s basically a urethroplasty failure,multiple DVIU does more harm than good, same goes about so-called self calibration.

  What he needs now is redo BMG urethroplasty.

  Further ( future, in case of further failure)options can be redo staged urethroplasty.

  Last resort perineal urethrostomy.

• 

  Jaideep Mahajani

  17 Mar 2020 05:06:06 PM

  Proximal bulbar urethra appears to be reasonable good. Mid bulbar urethra appears to be obliterated. He needs redo Dorsal Onlay Grafting. During redo DOG I excise the previously placed graft to create bed for new graft. If mid bulbar urethra is totally obliterated, it is better to excise short segment and then do DOG which then becomes very easy.

• 

  Dr. Anil Takvani

  17 Mar 2020 05:50:07 PM

  Jaydeep and Lalit,  

  Why not ventral onlay?

  Already operated case,  there will be excess fibrosis and issues related to vascularity. 

  Ventral is less traumatic with similar outcomes.  With do not require much dissection,  so less damage to tissues and vascularity. 

  Thanks 

• 

  Jaideep Mahajani

  17 Mar 2020 06:48:58 PM

  For proximal bulbar urethra I find VOD very difficult. It is ideal for mid & distal bulbar urethra. 

  As it is operated case, it is unlikely that bulbospongiosus will be healthy: so for ventral graft healthy bed will not be available. Hence it is likely to fail. 

  And if mid-bulbar urethra is totally obliterated, I will prefer to excise short segment. 

• 

  PANKAJ JOSHI

  17 Mar 2020 10:01:12 PM

  This is a Obliterative recurrence 

  Long stricture

  
  

  This Is precious surgery 

  We have sen few of this patients over time 

  Patient is on SPC means there is a almost obliterative stricture 

  Augmenting one wall may less likely Give long term cure  

  Mobilse uerthra circumferentially ,incise dorsally 

  We have performed Dorsal BMG with Ventral Pedicled flap to augment the obliterative plate  .

  The native sponge is used to cover the penciled flap decreasing the risk of Diverticulum formation .

  Good results -Long term 

  
  

  However if there is urethral plate and only augmentation is needed

  Dorsal approach would serve a better choice  for this stricture.

  

• 

  Amilal Bhat

  18 Mar 2020 10:26:33 AM

  Recurrent stricture Dorsal BMG with vetral if need be .

  Amilal Bhat 

  

• 

  Tikenjit Mazumdar

  20 Mar 2020 03:56:06 PM

   Thank u Sir,what is ur criteria to decide between single stage vs multiple stage procedure.