Ancillary maneuvers of tension-free anastomosis for the reconstruction of posterior urethral stenosis
10.3969/j.issn.1009-8291.2025.06.001
- VernacularTitle:后尿道狭窄重建无张力吻合的辅助操作
- Author:
Kaile ZHANG
1
;
Qiang FU
1
Author Information
1. Department of Urology, Shanghai 6th People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai Eastern Institute For Urological Repair and Reconstruction, Shanghai 200233, China
- Publication Type:Journal Article
- Keywords:
posterior urethral stricture;
repair and reconstruction;
ancillary maneuver;
surgical decision;
tension-free anastomosispelvic fracture
- From:
Journal of Modern Urology
2025;30(6):459-463
- CountryChina
- Language:Chinese
-
Abstract:
Posterior urethral stricture, especially bulbar and membranous urethral stricture after pelvic fracture, is the most common type of traumatic urethral stricture.Due to the special anatomical characteristics of the posterior urethral region, such stricture is difficult to be treated with urethral alternatives.Transperineal urethral anastomosis is the best surgical method, but it is difficult and risky in patients with complicated long posterior urethral stricture.This article reviewes the operations in our center, summarizes and analyzes a variety of urethral tension-free anastomosis adjuvant techniques. According to different stages of the surgical process, this article provides a detailed introduction to the “pre-anastomosis” stage techniques, including free dissection of bulbar urethra, free dissection of distal urethra, incision of the septum of corpora cavernosa, splitting of the inferior margin of the pubis; “intra-anastomosis” stage techniques, including transposition of the crura of corpora cavernosa penis, perineal skin flap, transposition of penis, anastomosis of bladder neck and urethra, transfer of bladder flap; “post-anastomosis” stage techniques, including plication of corpora cavernosa penis, suspension of corpora spongiosum urethra, and analyze its application scenarios, so as to provide reference for clinical practice.In addition, we propose an innovative evaluation system, which enables surgeons to select different tension release techniques according to the specific direction and length of the urethral defect to achieve an accurate anastomosis.These reduction strategies can not only promote the smooth operation of anastomosis, but also significantly reduce the recurrence rate of urethral stricture.
