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Management - Diversion

Uninary diversion for stricture urethral could be temporary or permanent. Temporary diversion with Supra Pubic Cystotomy (SPC) is required for pelvic urethral trouma and those patients who present with retention. After successful repair of the stricture, the temporary diversion tube is removed. Permanent diversion in the form of perineal urethrostomy is recommended and may be acceptable to older unfit patients and failed urethroplasty. Some patients after first stage repair with perineal urethrostomy may be happy and will not demand second stage repair. Rarely those patients with urinary incontinence and stricture urethra may need Mitrofanoff procedure or an Ileal conduit.

Urethroplasty - Bulbar Anastomotic

Anastomatic urethroplasty is a treatment of choice for bulbar urethral trauma. In past and in some centers anastomatic urethroplasty is performed for short bulbar stricture of non traumatic origin. In my practice, I follow the rule of transecting the bulbar urethra only when it is already transected by trauma. Under spinal anesthesia the patient is placed in lithotomy position. A midline perineal incision is made. The bulbo spongiosis muscle is incised in the midline. The dissection of the bulbo spongy muscle from the urethra is difficult at the site of injury due to fibrosis. The bulbar urethra is mobilized from the corpora cavernosa. A dilator is passed through meatus into the urethra. A firm nodule is felt in the corpora spongiosa at the site of injury and the urethra is transected this level. The spongio fibrotic tissue is excised on the proximal and the distal end of the urethra. The urethra is spatulated on both sides into normal pink urethra upto 1.5 cm. The anastomosis can be performed either with single suture line of interrupted 4 /0 vicryl sutures or in two layers. The first layer picks up urethral mucosa and can be continuous or interrupted. The second layer picks up the corpora spongiosa. A 14 F silastic Foley catheter is introduced into the bladder. The wound is closed in layers with absorbable sutures. I rarely use drain. The catheter is removed after three weeks.

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