Center for Reconstructive Urethral Surgery Arezzo …

1 Guido Barbagli E-mail: Website: for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryArezzo - ItalyCenter for Reconstructive Urethral Surgery28th Congress of the Soci t Internationaled UrologieCape Town South AfricaNovember 12 16, 2006 Professor John Quartey, FRCSC enter for Reconstructive Urethral SurgeryDedicated to John Quartey, respected colleague andfriend. His passing is a great personal as well as professionallossBuccal mucosal urethroplasty:how to do itCenter for Reconstructive Urethral SurgeryHarvesting buccal mucosal graft from theinner cheekCenter for Reconstructive Urethral SurgeryThe patient is intubated through the nose.

2 Allowing the mouth to be completely freeCenter for Reconstructive Urethral SurgeryTwo surgical teams work simultaneouslyCenter for Reconstructive Urethral SurgeryTwo sets of surgical instrumentsUrethroplastyBuccal mucosaCenter for Reconstructive Urethral SurgeryAppropriate mouthretractorOnly one assistant isneeded to harvest thebuccal graftCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral Surgerylength 4 cm width cmCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryAdvantages of the double team decrease of contamination in Surgery decrease of surgical time to ~ one hour provides training opportunity for a young assistant interested in learning Urethral surgeryCenter for Reconstructive Urethral SurgeryThe surgical techniquefor the repair of penileurethral strictures isselected according to thestricture etiologyPenile urethroplastyCenter for Reconstructive Urethral SurgeryEtiology of penile Urethral stricturesin 404 patients Failed hypospadias repair 40% Lichen sclerosus 40% Trauma Instrumentation Catheter Infection Other causes20%80%Barbagli 2006.

3 Unpublished dataCenter for Reconstructive Urethral Surgery trauma, instrumentation, catheter, infection and other causesIn patients with penile Urethral strictures due to:penis is normalCenter for Reconstructive Urethral Surgery One-stage dorsal inlay buccal mucosal grafturethroplastyCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral Surgery failed hypospadiasrepair lichen sclerosusIn patients with penile Urethral strictures due to:penis is abnormalCenter for Reconstructive Urethral SurgeryMulti-stage buccal mucosal grafturethroplastyCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryThe surgical techniquefor the repair of bulbarurethral strictures isselected according tostricture lengthBulbar urethroplastyCenter for Reconstructive Urethral Surgery Dorsal onlay techniques.

4 Augmented roof-strip anastomosis Dorsal onlay graft urethroplasty Ventral onlay techniqueBulbar urethroplasty using buccal mucosalgraftCenter for Reconstructive Urethral SurgeryPreparation of the patientSimple lithotomy positionAllen stirrups with sequentialinflatable compression sleevesCenter for Reconstructive Urethral SurgeryAugmented roof-strip anastomosis usingbuccal mucosal graft with fibrin glueCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryDorsal onlay buccal mucosal grafturethroplasty with fibrin glueCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive

5 Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryVentral onlay buccal mucosal grafturethroplastyCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryCenter for Reconstructive Urethral SurgeryI showed you the surgical techniques currently suggested forthe repair of penile and bulbar Urethral strictures usingbuccal mucosal graftsWhat appoach to take will be decided by you, yourexperience, your surgical background and your patients expectationsThere is nothing more I can tell you !

6 Thank you Center for Reconstructive Urethral SurgeryMadonna del Parto - Piero della Francesca Monterchi - ArezzoCenter for Reconstructive Urethral Surgery