Faculty Information |
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Language | Japanese |
The announcement title | Management of iatrogenic penile urethral stricture |
Academic Society name | The 110th Annual Meeting of the Japanese Urological Association |
Conference Type | Domestic Society |
Invitation | Invitation |
Announcement form | Oral presentation |
Presentation Type | Symposium/Workshop/Panel Discussion |
Lecture Type | シンポジウム・ワークショップ パネル(指名) |
Publisher and common publisher | Kanematsu Akihiro |
Date | 2023/04/21 |
Country | Japan |
Venue (city and name of the country) |
Kobe |
Holding period | 2023/04/20~2023/04/23 |
Society abstract | SY19-2 2023 |
Description | The etiology of stricture in native penile urethra is mostly iatrogenic. In addition, stricture in neourethra after hypospadias repair comprises a unique subgroup.
Corpus spongiosum is thinner in penile urethra than in bulbar urethra, and transurethral dilation or incision is ineffective. Cases after failed transurethral procedure require a few month of urethral rest period before urethroplasty. In most penile strictures, substitution urethroplasty is indicated, because anastomotic repair is not suitable for penile urethra for risk of penile bending. As free graft, buccal mucosa is preferred to preputial skin, but inner prepuce can be utilized as fasciculocutaneous island (McAninch) flap. Non-obliterative stricture of native urethra can be managed by one-stage graft repair. Obliterative stricture is more challenging, and one must choose either two-stage repair, or complex one-stage repair. Transscrotal penile inversion (Kulkarni) technique allows excellent exposure of entire anterior urethra. For post-hypospadias stricure, midline penile incision and midline dorsal buccal mucosa inlay (Asopa) procedure is our routine choice, but when remaining urethral plate is not wide or soft enough for one stage repair, staged repair is required. For older patients with significant morbidiy, perineal urethrostomy may be more realistic solution than substitution urethroplasty. Conversely, for younger patients, reconstruction of penile urethra implies restoration of integrity in male body image, and cosmetic sexual aspect should be well considered in surgical planning. |