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Complex strictures - Hypospadius Criple

I have already described the management of Hypospadius Criple in substitution urethroplasty.

Complex strictures - Watering can Perineum

Watering can perineum is a rare complication of extensive periurethral fibrosis leading to multiple abscesses and fistule in the perineum. These patients are continent but when the void urine leaks out through multiple holes in the perineum. In our serious the commonest cause of watering can perineum was BXO. The traditional operation described is Johansons two stage urethroplasty. In the first stage the urethra is opened ventrally and the skin edges are sutured to the urethromargins the fistulae are opened and excised. In the second stage, a 3cm wide “U” incision is made to tubularise the skin into urethra. During this procedure the perineal skin on both sides of the urethral plate of the narrow urethral plate is turned into urethra inside. Use of genital skin in BXO is not recommended so the failure rate of this procedure is high in BXO. We presented a new technique of urethroplasty for watering can perineum at 2002 AUA. In the first stage the bulbar urethra is mobilized from the corpora cavernosa opened dorsally the right edge of the urethra is fixed to the corpora cavernosa, the left edge of the urethra is fixed to the right edge of the skin. The left edge of the skin is fixed to the corpora cavernosa leaving a raw area of 1.5cm wide on the cavernosa. In step two, three months later the epithelium covering the corpora cavernosa is excised and replaced by buccal mucosa graft. The left edge of the urethra is released from the right skin margin and the urethra is used as a ventral plate to cover the buccal mucosa graft placed dorsally. The skin edges are sutured to close the wound. The advantage of our technique is genital skin is not utilized for this urethroplasty.

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