Urethroplasty is regarded as the gold standard treatment for urethral strictures and offers better outcomes in terms of recurrence rates than dilatations and urethrotomies.
[citation needed] Upon arrival to the preoperative admitting area, the patient will be instructed to don a surgical gown and be placed into a receiving bed, where monitoring of vital signs, initiation of a normal saline IV drip, and pre-surgical medication including IV antibiotics, and a benzodiazepine class sedative, usually diazepam or midazolam will be started/administered.
The subject area will be prepped by shaving, application of an antiseptic wash (usually povidone iodine or chlorhexidine gluconate - if sensitive or allergic to the former), surgically draped and placed in the Lloyd-Davies position.
Note: throughout the duration of the procedure, the patient's legs will be massaged and manipulated at predetermined intervals in an attempt to prevent compartment syndrome, a complication from circulatory and nerve compression resultant from the lithotomy positioning.
Particular care is used during the dissection to prevent damage to nerves and blood vessels (which could result in erectile dysfunction or loss of tactile sensation of the penis).
At this time, using micro surgical technique, the anastomosis is completed and fibrin glue is applied to the anastomotic suture line to help prevent leakage and fistula formation.
Some surgeons will inject a local anesthetic such as 2% plain lidocaine or 0.5% bupivicaine into the areas to allow the patient an additional period of relief from discomfort.
[citation needed] (a) some surgeons prefer the use of a suprapubic catheter, as they believe insertion of an in-dwelling urethral catheter may damage the anastomosed area[citation needed] Expected average success rate: The success rate for this procedure is above 95%, anastomotic urethroplasty is considered the "gold standard" of surgical repair options.
(a) Particular care is used during the dissection to prevent damage to nerves and blood vessels (which could result in erectile dysfunction or loss of tactile sensation of the penis).
Some surgeons will inject a local anesthetic such as 2% plain lidocaine or 0.5% bupivicaine into the areas to allow the patient an additional period of relief from discomfort.
(a) At this time, some surgeons prefer to insert a safety guide (as used in urethrotomy) from the urinary meatus, through the stricture, and into the bladder for purposes of maintaining positioning.
(a) Particular care is used during the dissection to prevent damage to nerves and blood vessels (which could result in erectile dysfunction or loss of tactile sensation of the penis).
Some surgeons will inject a local anesthetic such as 2% plain lidocaine or 0.5% bupivicaine into the areas to allow the patient an additional period of relief from discomfort.
(a) At this time, some surgeons prefer to insert a safety guide (as used in urethrotomy) from the urinary meatus, through the stricture, and into the bladder for purposes of maintaining positioning.
As with the buccal mucosal onlay, surgeons have been performing the dorsal aspect procedure since the late 1990s, with an estimated success rate approaching 90%.
An appropriately sized in-dwelling catheter is inserted, and the repaired area is temporarily closed (sutured in some locations, with packing and dressings in others) until the newly created diversion forms completely, usually within six months.
After sufficient awakening from the anesthetic agent has taken place, and if the patient is a candidate for same day discharge, he (and the person responsible for his transport home) will be instructed in the care and emptying of the catheter and its drainage system, cleansing of the involved area(s) and methods/intervals for dressing change, monitoring for signs of infection and for signs of catheter blockage.
[1][13] [8] Comparing the two surgical procedures, a UK trial found that both urethrotomy and urethroplasty are effective in treating urethral stricture in the bulbar region.