Flap with preserved blood supply
In the penile region, the urethra lies close to the skin, is surrounded by a thin corpus spongiosum, and nourishes free grafts less well than the bulbous urethra. Here, flaps of penile skin are used, cut together with the subcutaneous vascular network and turned towards the defect without cutting off from the power source. For large defects, the island flap is combined with the buccal mucosa: one tissue forms the “roof”, the other the “bottom” of the new urethra. The method is especially valuable after hypospadias and during repeated operations. The presence of hair on the skin is taken into account when choosing a donor site.
Indications for urethroplasty
- extended urethral stricture (more than 1–1.5 cm) of any location;
- recurrence of stricture after one or more urethrotomies and bougienages;
- post-traumatic strictures and obliterations (urethral rupture due to pelvic fracture);
- strictures after TUR, adenomectomy, radical prostatectomy (narrowing of the anastomosis);
- obliteration of the posterior urethra - anastomotic plasty with pubectomy;
- strictures with lichen sclerosus (panurethral buccal plastic surgery);
- impossibility of reconstruction - formation of a perineal urethrostomy.
Types of operations
Anastomotic urethroplasty is used for short (up to 2–3 cm) strictures of the bulbous urethra and post-traumatic obliterations: the scar is completely excised, and the healthy ends of the urethra are sutured without tension. In posterior obliteration after a pelvic injury, part of the pubic bone is removed to bring the ends together (pubectomy). Efficiency - 90–95%.
Buccal urethroplasty is the standard for extended strictures: the urethra is dissected along the stricture, and the lumen is expanded with a mucosal flap taken from the inner surface of the cheek. This flap is resistant to humid environments and takes root well; a wound in the mouth heals in 1–2 weeks. Island plasty uses a flap of penile skin on a vascular pedicle, while panurethral plasty restores the entire urethra in case of total damage. Johanson's operation is a staged plastic surgery for complex strictures: first, the urethra is opened and a platform is formed, after 6 months - the second stage. Urethrovesicoanastomosis restores the connection of the urethra to the bladder after radical prostatectomy. Perineal urethrostomy - removal of the urethra to the perineum when reconstruction is impossible.
Preparation
The examination determines the type of plastic surgery: retrograde and voiding urethrography, urethroscopy, ultrasound of the urethra show the extent and depth of the scar. Urine culture is required to treat the infection; in case of cystostomy, sanitation is required. Standard tests, ECG, consultations with an anesthesiologist and, if necessary, a therapist. Before buccal plastic surgery, the oral cavity is sanitized by a dentist. Hospitalization the day before, 8 hours on an empty stomach.
Recovery
The patient spends 3–7 days in the hospital. The urethral catheter is in place for 2–3 weeks; before removal, a control urethrography is performed - if the anastomosis is tight, the catheter is removed and urination is restored with a free stream. The wound on the perineum heals in 2-3 weeks, in the mouth - 1-2 weeks (soft foods, rinses). Physical activity is limited to 4–6 weeks, sexual activity is limited to 6 weeks. Uroflowmetry monitoring at 3, 6 and 12 months, then annually. The effectiveness of anastomotic plasty is 90–95%, buccal plasty is 85–90%; relapses are rare and can be corrected by urethrotomy alone.
Urethroplasty in Tashkent
Reconstructive urethral surgery requires specialization: in the clinics below, all types of urethroplasty are performed - anastomotic, buccal, island, panurethral, operations for posterior obliteration with pubectomy, urethrovesicoanastomosis and urethrostomy. Prices according to the clinic’s price list; Anesthesia and bed days are paid separately. Sign up for a consultation with urethrograms - the surgeon will determine the type of operation.
