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
Be First to Comment