Over the past decade, the main advances in urethral surgery have been in the areas of :
- The limits of endoscopic treatments,
- The good results of urethroplasty techniques,
- The importance of managing the urethroplasty learning curve.
This open access postgraduate teaching site aims to focus on how to organize the training of experienced urological surgeons who wish to devote themselves to urethral surgery.
The proposed course of training includes the following:
- Follow the course on the anatomy of the male urethra.
- Follow the introductory course on urethral stricture surgery (below).
- Build and complete a personal surgical training program with magnifying glasses on short general urological procedures (circumcision, cryptorchidism, hydrocele) before the first urethroplasties.
- If possible, train in the dissection of the membranous urethra by simulation on an anatomical lab.
- Respect the difficulty rating for each type of urethroplasty (from 1 star to 5 stars) and perform at least 5 “1 star” procedures before moving 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 center.
- It should be noted that this is a self-training course that 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 augmented urethroplasties by oral mucosal grafting being 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.
Therefore, urethroplasty has a special and central place which this site aims to facilitate.
There is little interest in excision and primary anastomosis for apparently short stricture:
Although it is easy to perform. However, the length of the stricture is generally much greater than the X-ray would suggest.
This surgery 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 stricture.
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 augmented plasty at the site of the anastomosis at the same time as the terminal urethrogram.
To read more about the subject of Anatomy, Inaugural Course, or Basic Techniques, check out our articles and posts.