Muscle-, Nerve-, and Vascular-Sparing Techniques in Anterior Urethroplasty
The most common site for urethral strictures is the bulbar urethra. Augmentation urethroplasty with oral mucosa patch is the treatment of choice for strictures of the urethra where anastomotic urethroplasty is considered inappropriate. The bulbo-spongio-cavernosus muscle has two parts. The bulbospongiosus surrounds the bulbar urethra in its proximal two-thirds, circumferentially. Its function is to help expel urine and semen. The bulbocavernosus part surrounds the corpora cavernosa in the distal one-third. Its function is to compress the deep dorsal veins of the penis and base of the corpora cavernosa to aid erection. Incision of the muscle may lead to post micturition dribble and decreased force of ejaculation. Ventral onlay oral mucosa graft urethroplasty can be performed by retracting the muscle inferiorly without incising it.
During dorsal onlay oral mucosa graft urethroplasty, it is unnecessary to incise the muscle twice – once, ventrally to expose the bulbar urethra and, again, dorsally to open the urethra for grafting. For pan-urethral stricture repair, the one-sided dissection of the urethra allows for preservation of the neurovascular tissue. The penile invagination technique avoids a penile incision. Vessel-preserving urethroplasty has some distinct advantages in patients who require both an artificial sphincter and an anastomotic urethroplasty.
KeywordsCorpus Cavernosa Urethral Stricture Artificial Urinary Sphincter Urethral Plate Corpus Spongiosa
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