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Atlas of Urethroplasty
Rajesh Gulia, Richard Santucci
CHAPTER 1:
Back to the Basics: Penoscrotal Anatomy
INTRODUCTION
GENITAL FLAP SELECTION
PENOSCROTAL FASCIAL ANATOMY
PENILE VASCULAR ANATOMY
Arterial
Venous
SCROTAL VASCULAR ANATOMY
Arterial
Venous
SURGICAL PEARLS
Arterial Anatomy and Implications for Urethral Stricture Repair
Urethrotomy
Anterior Urethroplasty/Excision and Primary Anastomosis
Posterior Urethroplasty
Postprostatectomy Stricture
Venous Anatomy
Urethral Elasticity
Urethral Location within Corpus Spongiosum
CHAPTER 2:
Urethral Stricture Disease: Etiology, Pathophysiology and its Economic Impact
INCIDENCE
ETIOLOGY
Anterior Urethral Stricture
Posterior Urethral Stricture
HISTOLOGY
PATHOPHYSIOLOGY OF STRICTURE URETHRA
Classification
ECONOMIC IMPACT
How do Costs Compare for these Two Procedures?
EDITORIAL COMMENTS
CHAPTER 3:
Imaging in Stricture Urethra
INTRODUCTION
X-RAY KIDNEY, URETER, BLADDER
RETROGRADE URETHROGRAM
Technique
Position
Materials
Films
MICTURATING CYSTOURETHROGRAM
UP AND DOWNOGRAM
Steps
Features to be Seen in a Urethrogram
PERICATHETER URETHROGRAM
NORMAL ANATOMY OF THE URETHRA ON URETHROGRAM
Complications of Urethrogram
Pitfalls in Urethrogram
ULTRASONOGRAPHY
Abdominal Ultrasound
Color Doppler of the Penis
Urethrosonography
Advantages of Sonourethrography
Disadvantages of Sonourethrography
MAGNETIC RESONANCE IMAGING
CONCLUSION
EDITORIAL COMMENTS
Decoding Erectile Dysfunction in PFUDD
Normal Sonogram of the Penis
Doppler Findings in Various Phases of Erection
Certain Points in Interpretation of Penile Doppler
Procedure of Penile Doppler (Steps)
Neurogenic Impotence
Acknowledgments
CHAPTER 4:
The Role of Urethrotomy and Other Minimally Invasive Interventions
INTRODUCTION
URETHRAL DILATION AND DIRECT VISUAL INTERNAL URETHROTOMY
Introduction
Results of Dilation and Urethrotomy
Procedure/Technique of Dilation/Urethrotomy
Postoperative Care after Dilation/Urethrotomy
Alternatives to Dilation/Urethrotomy
STENTS
Introduction
Results of Urethral Stents
Procedure/Technique for Urethral Stent Placement
Postoperative Care after Urethral Stents
Alternatives to Urethral Stent Procedure
ENDOSCOPIC REALIGNMENT OF PFUDD
Introduction
Results of Endoscopic Realignment of PFUDD
Procedure/Technique for Endoscopic Realignment of PFUDD
Procedure/Technique for Endoscopic Incision of PFUDD
Postoperative Care
Alternatives to Endoscopic Realignment of PFUDD
ENDOSCOPIC URETHROPLASTY
Introduction
Results of Endoscopic Urethroplasty
Procedure/Technique of Endoscopic Urethroplasty
Postoperative Care after Endoscopic Urethroplasty
Alternatives to Endoscopic Urethroplasty
CONCLUSION
CHAPTER 5:
Fossa Navicularis and Meatal Strictures
INTRODUCTION
HISTORY
TECHNIQUE
Extended Meatotomy
Ventral Transverse Island Penile Skin Flap
Modified Transverse Island Skin Flap Procedure
Buccal Mucosal Graft Urethroplasty
Single Stage Buccal Mucosal Graft Ventral Onlay
Multistaged Distal Urethral Reconstruction
EDITORIAL COMMENTS
CHAPTER 6:
Anastomotic Urethroplasty
INTRODUCTION
INDICATIONS
Penile Urethra
Bulbar Urethra
Posterior Urethra
INVESTIGATIONS
History and Examination
Blood and Urine Tests
Uroflowmetry
Ultrasonography
Penile Doppler
Sonourethrography
Retrograde and Micturating Cystourethrography
Cystourethroscopy
Computed Tomography Scan and Magnetic Resonance Imaging
PREOPERATIVE PREPARATION AND ANESTHESIA
OPERATIVE STEPS
Bulbar Anastomotic Urethroplasty
Follow-up
Anastomotic Urethroplasty for Posterior Urethral Injury
Perineoabdominal Progression Approach
Postoperative Care and Follow-up
Augmented Anastomosis
Operative Steps
ANASTOMOTIC URETHROPLASTY:CONCEPTS
Urethral Anatomy
Dual Vascularity
Penile Urethra
Bulbar Urethra
Posterior Urethra
Urethral Extensibility
Technical Concepts
Adequate Urethral Mobilization
Complete Scar Excision
Adequate Urethral Spatulation
Surgical Skill and Expertise
COMPLICATIONS OF ANASTOMOTIC URETHROPLASTY
Intraoperative and Perioperative
Uncontrolled Bleeding
Injury to the Rectum
Inability to Complete the Anastomosis
Perurethral Catheter Displacement
Pubic Osteomyelitis
Others
Postoperative
Anastomotic Site Leak
Recurrent Stricture
Erectile Dysfunction
Urinary Incontinence
Penile Shortening or Chordee
OUTCOMES OF ANASTOMOTIC URETHROPLASTY
Complex Situations
ANASTOMOTIC URETHROPLASTY IN NONTRAUMATIC BULBAR URETHRAL STRICTURES (ESPECIALLY THE VERY SHORT SEGMENT ONES)
Traumatic Bulbar Strictures
Nontraumatic Bulbar Strictures (Short Segment)
Methylene Blue Color Spongiography
EDITORIAL COMMENTS
CHAPTER 7:
Bulbar Oral Graft: Buccal Mucosal Graft, Urethroplasty
INTRODUCTION
PREOPERATIVE INVESTIGATIONS
PATIENT PREPARATION
VENTRAL ORAL MUCOSAL GRAFT URETHROPLASTY
Patient Selection
Surgical Technique
Results
Alternative to this Procedure
DORSAL ORAL MUCOSAL GRAFT URETHROPLASTY
Patient Selection
Surgical Technique
Results
Alternative to this Procedure
AUGMENTED ANASTOMOTIC REPAIR USING ORAL GRAFT
Patient Selection
Surgical Technique
Results
Alternative to this Procedure
POSTOPERATIVE CARE AFTER BULBAR URETHROPLASTY USING AN ORAL GRAFT
CHAPTER 8:
Free Graft Urethroplasty by Ventral Sagittal Urethrotomy Approach
INTRODUCTION
PREOPERATIVE EVALUATION
SURGICAL TECHNIQUES
Dorsal Free Graft Urethroplasty by Ventral Sagittal Urethrotomy Approach in Penile Urethral Strictures
Step 1
Step 2
Step 3
Step 4
Dorsal Free Graft Urethroplasty in Bulbar Urethral Strictures5
Step 1
Step 2
Step 3
Step 4
Dorsal Free Graft Urethroplasty in Panurethral Strictures
Step 1
Step 2
Step 3
Step 4
Combined Dorsal and Ventral Free Graft Urethroplasty by Ventral Sagittal Urethrotomy Approach
Surgical Technique
Ventral Free Graft
Postoperative Assessment
RESULTS OF VENTRAL SAGITTAL URETHROTOMY APPROACH
COMMENTS
Advantages
EDITORIAL COMMENTS
CHAPTER 9:
Penile Fasciocutaneous Flap: McAninch Procedure
INTRODUCTION
FLAP ANATOMY
Buck's Fascia
Dartos Fascia
PATIENT SELECTION
SURGICAL TECHNIQUE
Patient Positioning
Fasciocutaneous Flap Harvest
Stricture Exposure
Anastomosis
Special Circumstances
Postoperative Care or Monitoring
OUTCOMES
COMPLICATIONS
ALTERNATIVES TO THE McANINCH FLAP
CONCLUSION
CHAPTER 10:
Staged Urethral Reconstruction
INTRODUCTION
STAGED RECONSTRUCTION OF THE FOSSA NAVICULARIS4,5
First Stage: Grafting
Buccal Mucosa Graft Harvesting8,9
Graft Onlay
Second Stage: Neourethral Tubularization
ANTERIOR PANURETHRAL STAGED BUCCAL MUCOSA GRAFT RECONSTRUCTION
First Stage
Second Stage
COMPLICATIONS
Oral Mucosa Graft Harvesting
Second Stage: Neourethral Tubularization
CONCLUSION
EDITORIAL COMMENTS
CHAPTER 11:
Perineal Urethrostomy
INTRODUCTION
BACKGROUND
INDICATIONS AND CONTRAINDICATIONS
Indications
Relative Contraindications
SURGERY
Recommended Equipment
Patient Preparation
Positioning
Surgical Steps
Postoperative Care
OUTCOMES
DISCUSSION AND CONCLUSION
SURGICAL PEARLS
EDITORIAL COMMENTS
CHAPTER 12:
Female Urethroplasty
INTRODUCTION
FEMALE URETHRAL ANATOMY
URETHRAL DILATION AND URETHROTOMY
FEMALE URETHROPLASTY TECHNIQUES
The Vaginal Inlay Flap
Female Urethroplasty with Buccal Mucosa
Urethroplasty Using a Dorsal Buccal Graft
POSTOPERATIVE CARE
COMPLICATIONS
CONCLUSION
EDITORIAL COMMENTS
CHAPTER 13:
Stricture after Transurethral Resection of the Prostate, Radical Retropubic Prostatectomy and Radiation Therapy
INTRODUCTION
STRICTURE AFTER RADIATION THERAPY FOR PROSTATE CANCER
URETHROPLASTY FOR RADIATION-INDUCED STRICTURES OF THE BULBOMEMBRANOUS URETHRA
Positioning
Mobilization of Urethra
Division of Urethra
Placement of Anastomotic Sutures
Closure
Follow-up
Continence
STRICTURE AFTER TREATMENT FOR BENIGN PROSTATIC DISEASE
OPEN SURGERY FOR BLADDER NECK CONTRACTURE: ANTERIOR BLADDER FLAP
Patient Positioning
Exposure
Bladder Flap Development
Inset of Flap and Closure
Follow-up
STRICTURE AFTER RADICAL PROSTATECTOMY
VESICOURETHROPLASTY AFTER RADICAL PROSTATECTOMY
Coordination and Patient Positioning
Abdominal Approach
Perineal Approach
Superior Pubectomy
Urethral Anastomosis
Closure
Follow-up
CHAPTER 14:
Tissue Engineering in the Management of Urethral Strictures
INTRODUCTION
BIOMATERIALS AND WOUND HEALING
CHOOSING A BIOMATERIAL
CLASSES OF BIOMATERIALS
Acellular Tissue Matrices
Synthetic Polymers
Comparison of Biological and Synthetic Materials
SYNTHETIC BIOMATERIALS IN URETHRAL RECONSTRUCTION
NATURAL BIOMATERIALS IN URETHRAL RECONSTRUCTION
Unseeded Matrices
Seeded Matrices
FUTURE DIRECTIONS
Alternative Cell Sources for Scaffold Seeding
Cell-seeded Synthetic Materials
CHAPTER 15:
From the Patients' Perspective
PATIENT
DOCTOR
WHAT AND HOW TO COUNSEL
Restricture
Possible Problems
Patient
Doctor
Sexual Function
Doctor
Other Precautions
INDEX
TOC
Index
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