A novel staged procedure for those long-segment post-traumatic posterior urethral distraction defects and short segments of patent pendulous urethra is described in two patients by D.L. Wu and colleagues from Shanghai, China. The paper is published in the February 2007 issue of European Urology.

Both patients presented were young 20 year-old males who had undergone multiple prior attempts (one had 3 prior perineal attempts and at least 4 prior endoscopic attempts) at repair of their complex posterior urethral distraction defects. Patient one had a urethral gap of 6.5 cm and patient 2 had a 10 cm segment of occlusive and absent urethra. Both had approximately 6 cm of salvageable pendulous urethra.

The three stage procedure is described in great detail with both figures and operative photos. Stage one consists of mobilization of the pendulous urethra down to the proximal prostatic urethrotomy and which time the penis and urethra meatus is transposed to the perineum through the scrotal septum incision. The patient voids by squatting after this stage. The second stage is performed 6 months later and involves transecting the urethra at the coronal sulcus, straightening of the penis and perineal urethrostomy. The absent urethral defect is allowed to epithelialize and then what is essentially a second-stage Johanson urethroplasty is performed 6 months later as the third and final stage. The operative pictures and drawings help with the understanding of this complex procedure.

Both patients did well post-operatively and were voiding well with no additional procedures required after 3 and 2 years respectively. The authors describe this unique approach for use in patients in whom an anastomotic urethroplasty, even with utilization of the four-step urethral mobilization described by George Webster, would not allow for a tension-free anastomosis. An editorial comment provided by Enzo Palminteri applauds the efforts of the authors and adds that the laying of a buccal mucosa graft at the time of the second stage operation may prove beneficial to achieve long-term success for the third stage Johanson-type repair.

Deng-Long Wu, San-Bao Jin, Juan Zhang, Yong Chen, Chong-Rui Jin, Yue-Min Xu

Eur Urol. 2007 Feb. 51(2):504-11

UroToday.com Urologic Trauma & Reconstruction Section

Written by Michael J. Metro, MD, a Contributing Editor with UroToday.

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