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THE URETHRAL RECONSTRUCTION: 4 IMPORTANT QUESTIONS

Urethral reconstruction is the creative application of tissue transfer principles, and it is more an art than a science. In this page 4 important questions to urethral reconstruction.

Why do failures occur with the urethral reconstruction?

Surgical experience, procedure selection, operative technique, stricture location and nature of the disease all influence outcome. A multivariate analysis showed that longer strictures were more likely to fail long term, even when the same method of repair was used in various locations. It may be that longer strictures simply "outgrow" the repair over time in some cases, especially those originating from chronic inflammatory conditions such as lichen sclerosus.

How do the frequency and timing of urethral dilations influence stricture length and urethral reconstruction results?

Andrich et al suggest that repeated dilation tends to exacerbate simple strictures.They note an increasing trend toward immediate urethral reconstruction, which appears to have yielded procedure simplification and improved outcomes during the last decade. We have observed that most strictures not previously subjected to repeated instrumentation are amenable to an anastomic procedure, while those that have been frequently manipulated often require tissue transfer. Another underappreciated point is that many experts advise at least a 3-month period of "urethral rest" to enable clear distinction between normal and scarred tissue at the time of urethral reconstruction.

How does the surgeon decide which procedure to perform in the urethral reconstruction

Stenosis are difficult to measure precisely in length and severity. The London group reports excellent results when short strictures are treated by an anastomotic procedure but they do not prescribe specific guidelines for procedure selection. Ultrasound, while helpful in select cases, has not been widely used due to time and cost constraints.

What do the patients think about various procedures of "urethral reconstruction"?

With an increasing trend toward performing single stag urethroplasty as an outpatient procedure, multistage procedures should be reserved for a selvage setting, as in reoparative hypospadias cases and those with extremely advanced stricture diseases. The most sexually active patients prefer single stafe for urethral reconstruction.

 

 
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