The main advances in urethral surgery over the past decade have been in the area of :
- The limits of endoscopic treatments
- The good results of urethroplasty techniques
- The importance of managing the urethroplasty learning curve
This is the main focus of this open access postgraduate teaching site: how to organise the training of an experienced urological surgeon wishing to devote himself to urethral surgery?
The course of training proposed here is :
- Follow the course on the anatomy of the male urethra
- Follow the introductory course on urethral stenosis surgery (below)
- Self build and complete, before the first urethroplasties, a personal surgical training programme with magnifying glasses on short general urological procedures (circumcision, cryptorchidism, hydrocele)
- If possible, training in dissection of the membranous urethra by simulation on anatomical lab
- Respect the difficulty rating for each type of urethroplasty (from 1 star to 5 stars) with the need to perform at least 5 “1 star” procedures before accessing on to the next level
- Perform urethral strictures first before considering traumatic interruptions and reconstructed urethral strictures (after hypospadias in particular): the latter are the responsibility of an expert centre
- It should be noted that this is a self-training course which does not lead to any certification. It is offered to qualified and experienced surgeons.
Urethroplasties have high success rates:
In the literature, the success rate of enlargement urethroplasties by oral mucosal grafting is between 80 and 90% at 5 years, whereas that of endoscopic treatments is 20% for the anterior urethra and 50% for the bulbo-membranous urethra.
Urethroplasty therefore has a very special and central place which this site aims to facilitate.
There is little interest in terminal urethrorrhaphy for apparently short stenoses:
This relatively easy to perform technique is not as good as it seems because the length of the stenosis is generally much greater than the X-ray would suggest.
This surgery, on the other hand, is associated with a resection of the spongiosum and therefore a shortening associated with devascularisation. It is not reasonable to propose it in the case of a simple stenosis.
In the case of an interruption, particularly traumatic, the question is different and we are obliged to use it, bearing in mind that, particularly in the case of a straddling fall, it is reasonable to provide a small enlargement plasty at the site of the anastomosis at the same time as the terminal urethrogram.
Read more articles on the subject Anatomy, Inaugural Course or Basic Techniques