Background: Urethroplasty requires meticulous attention to tissue qualityand complete resection or grafting of the stenotic lesion to ensure adequatehealing. Preoperative retrograde urethrogram (RUG) gives valuable informationregarding stricture number, length and location. However, it doesnot assess tissue quality and it poorly predicts the distance of the proximalaspect of the stricture from the voluntary sphincter. We describe our seriesof urethroplasties performed with concomitant urethral evaluation with arigid ureteroscope. Urethroscopy with the narrow caliber ureteroscopereliably determines stricture quality, length, number, and distance fromthe sphincter. It also allows evaluation of the prostatic urethra and bladderwith direct visual intraluminal placement of a guidewire, all of whichfacilitates urethroplasty.Methods: Retrospective review was performed on urethroplasties performedfrom July 2012-April 2014 by a single surgeon. Operative details obtainedfrom rigid urethroscopy were recorded including stricture location, length,quality, and distance from the sphincter. The presence of bladder trabeculations,lesions or prostatic hypertrophy on urethroscopy and urethroplastyfindings were also recorded.Results: Sixty-two urethroplasties were performed including 10 first stageurethroplasties. Rigid ureteroscope urethroscopy was performed in 63%(39/62) of cases. Bladder stones or foreign bodies were noted in three caseswith removal prior to urethroplasty. Bladder trabeculations were noted in 4cases. Prostatic hypertrophy with coapting lobes and a prominent medianlobe was noted in one patient. Stricture length, location, and distance fromthe striated sphincter was noted. Patients with confirmed bulbar strictures 2cm 39%(24/62) underwent ventral onlay urethroplasty, and patientswith distal bulbar or penile urethral strictures 16%(10/62) underwent dorsalonlay urethroplasty. Intraluminal guidewires were inserted at time ofurethroscopy in all patients to facilitate urethral lumen identification andurethrotomy. An additional case demonstrated a large false passage whichcould have been mistaken for a urethral lumen. Subjective assessmentof tissue quality surrounding the stricture was noted to be helpful by theprimary operating surgeon. Poor quality tissue required dorsal and ventralonlay urethroplasty with plans made for additional graft harvesting.Conclusions: Rigid ureteroscope urethroscopy with intraluminal wireplacement prior to perineal or penile skin incision assists in intraoperativeplanning and facilitates urethroplasty. Additionally it may add therapeuticinformation for postoperative symptoms from other urologic problems suchas benign prostatic hyperplasia (BPH). It is quick and easy to perform priorto urethroplasty and adds valuable information for the surgeon. We haveadopted it as standard procedure for urethroplasties at our institution.
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