The surgical technique of “End-to-end anastomosis” is made by transecting the urethra at the level of the stricture site, removing the scar tissue and performing a direct anastomosis between the two urethral edges. This surgical technique is one of the fist operations described in the repair of urethral strictures
Figure 1 |
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Figure 3 |
Figure 4 |
Basically, there are two basic types of End-to-end anastomosis:
- End-to-end anastomosis. Using this technique, the scar tissue involving the stricture is completely removed and the new urethral lumen is made on healthy tissue with an adequate caliber (figures 1,2).
- End-to-end anastomosis with skin or oral mucosal graft. Using this technique, the scar tissue involving the stricture is completely removed and the new urethral lumen is made on healthy tissue with an adequate caliber over the graft (figures 3,4).
The surgical technique of End-to-end anastomosis is generally suggested in the following cases:
- patients with traumatic bulbar urethral strictures, not more than 2 cm in length.
- patients who had undergone previous failed surgical attempt to repair urethral strictures showing a recurrent fibrous stricture not more than 2 cm in length.
Lecture n° 1:
Penile and bulbar urethroplasty Surgical techniques and results Hong Kong Urological Association Urethroplasty Workshop Division of Urology – Tuen Mun Hospital February 9 – 10, 2009 Hong Kong |
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Article n° 1
Barbagli G, Palminteri E, Rizzo M.
Dorsal onlay graft urethroplasty using penile skin or buccal mucosa in adult bulbourethral strictures.
J Urol. 1998 Oct;160(4):1307-9
Article n° 2
Barbagli G, Palminteri E, Lazzeri M.
Dorsal onlay techniques for urethroplasty
Urol Clin North Am. 2002 May;29(2):389-95
Article n° 3
Barbagli G, Palminteri E, Balò S, Picinotti A, Lazzeri M.
Dorsal onlay graft urethroplasty. Current technique step-by-step.
Contemporary Urology, 2002: 14(5), 18-32
Article n° 4
Barbagli G, Palminteri E, Lazzeri M, Guazzoni G.
Anterior urethral strictures.
BJU Int. 2003 Sep;92(5):497-505.
Article n° 5
Barbagli G, Palminteri E, Lazzeri M, Bracka A.
Penile and bulbar urethroplasty using dorsal onlay techniques.
Atlas Urol Clin., 2003: 11, 29-41
Article n° 6
Barbagli G, Palminteri E, Guazzoni G, Montorsi F, Turini D, Lazzeri M.
Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique?
J Urol. 2005 Sep;174(3):955-7
Article n° 7
Barbagli G, De Stefani S, Sighinolfi MC, Annino F, Micali S, Bianchi G.
Bulbar urethroplasty with dorsal onlay buccal mucosal graft and fibrin glue.
Eur Urol. 2006 Sep;50(3):467-74. Epub 2006 Jun 5
Article n° 8
Barbagli G, De Stefani S, Sighinolfi MC, Pollastri CA, Annino F, Micali S, Bianchi G.
Experience with fibrin glue in bulbar urethral reconstruction using dorsal buccal mucosa graft.
Urology. 2006 Apr;67(4):830-2.
Article n° 9
Barbagli G., Guazzoni G., Lazzeri M.
One-Stage bulbar urethroplasty: Retrospective analisys of the results in 375 patients
Eur Urol 2008; 53:828 – 33
Article n° 10
Barbagli G, De Stefani S, Annino F, De Carne C, Bianchi G.
Muscle- and Nerve-sparing Bulbar Urethroplasty: A New Technique.
Eur Urol 2008; 54:335 – 343
Barbagli G, Palminteri E, Rizzo M.
Dorsal onlay graft urethroplasty using penile skin or buccal mucosa in adult bulbourethral strictures.
J Urol. 1998 Oct;160(4):1307-9
Article n° 2
Barbagli G, Palminteri E, Lazzeri M.
Dorsal onlay techniques for urethroplasty
Urol Clin North Am. 2002 May;29(2):389-95
Article n° 3
Barbagli G, Palminteri E, Balò S, Picinotti A, Lazzeri M.
Dorsal onlay graft urethroplasty. Current technique step-by-step.
Contemporary Urology, 2002: 14(5), 18-32
Article n° 4
Barbagli G, Palminteri E, Lazzeri M, Guazzoni G.
Anterior urethral strictures.
BJU Int. 2003 Sep;92(5):497-505.
Article n° 5
Barbagli G, Palminteri E, Lazzeri M, Bracka A.
Penile and bulbar urethroplasty using dorsal onlay techniques.
Atlas Urol Clin., 2003: 11, 29-41
Article n° 6
Barbagli G, Palminteri E, Guazzoni G, Montorsi F, Turini D, Lazzeri M.
Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique?
J Urol. 2005 Sep;174(3):955-7
Article n° 7
Barbagli G, De Stefani S, Sighinolfi MC, Annino F, Micali S, Bianchi G.
Bulbar urethroplasty with dorsal onlay buccal mucosal graft and fibrin glue.
Eur Urol. 2006 Sep;50(3):467-74. Epub 2006 Jun 5
Article n° 8
Barbagli G, De Stefani S, Sighinolfi MC, Pollastri CA, Annino F, Micali S, Bianchi G.
Experience with fibrin glue in bulbar urethral reconstruction using dorsal buccal mucosa graft.
Urology. 2006 Apr;67(4):830-2.
Article n° 9
Barbagli G., Guazzoni G., Lazzeri M.
One-Stage bulbar urethroplasty: Retrospective analisys of the results in 375 patients
Eur Urol 2008; 53:828 – 33
Article n° 10
Barbagli G, De Stefani S, Annino F, De Carne C, Bianchi G.
Muscle- and Nerve-sparing Bulbar Urethroplasty: A New Technique.
Eur Urol 2008; 54:335 – 343
1. Question: What kind of anesthesia is used for this surgery?
Answer: General anesthesia with nasal intubation.
2. Question: How many hours does the surgery take?
Answer: About 2 hours.
3. Question: Are there any risks concerning erection, fertility and urinary incontinence after the surgery?
Answer: No, there aren’t.
4. Question: How many days of hospital recovery are expected following the surgery?
Answer: In general, from 5 to 7 days.
5. Question: How long will I have to use a catheter after the surgery?
Answer: The urethral catheter must stay in place for four weeks after the surgery, when the first post-operative voiding urethrography is done.
6. Question: Are there any particular recommendations during convalescence?
Answer: During convalescence, the use antibiotics until the catheter is removed is suggested. Avoiding long car trips, as well as heavy labor and sexual and sports activities are also suggested.
7. Question:When will I be able to resume my working, sexual and sports activities?
Answer: All these activities can be gradually resumed about 30 days after the removal of the catheter.
8. Question: Can I ride a bike or a motorcycle immediately after the surgery?
Answer: It is not recommended to ride bikes, motorcycles or horses after the surgery.
9. Question: What kinds of foods and drinks should be avoided after the surgery?
Answer: Beer and sparkling wines should be avoided, as well as large quantities of chocolate, cocoa, nuts and shellfish.
Answer: General anesthesia with nasal intubation.
2. Question: How many hours does the surgery take?
Answer: About 2 hours.
3. Question: Are there any risks concerning erection, fertility and urinary incontinence after the surgery?
Answer: No, there aren’t.
4. Question: How many days of hospital recovery are expected following the surgery?
Answer: In general, from 5 to 7 days.
5. Question: How long will I have to use a catheter after the surgery?
Answer: The urethral catheter must stay in place for four weeks after the surgery, when the first post-operative voiding urethrography is done.
6. Question: Are there any particular recommendations during convalescence?
Answer: During convalescence, the use antibiotics until the catheter is removed is suggested. Avoiding long car trips, as well as heavy labor and sexual and sports activities are also suggested.
7. Question:When will I be able to resume my working, sexual and sports activities?
Answer: All these activities can be gradually resumed about 30 days after the removal of the catheter.
8. Question: Can I ride a bike or a motorcycle immediately after the surgery?
Answer: It is not recommended to ride bikes, motorcycles or horses after the surgery.
9. Question: What kinds of foods and drinks should be avoided after the surgery?
Answer: Beer and sparkling wines should be avoided, as well as large quantities of chocolate, cocoa, nuts and shellfish.
Up-to-date to 12-31-2021 | |||
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Surgical Technique: step by step
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