RESIDENT DEBATE ON urethroplasty - Copy.pptx

residents debate

1. SHORT SEGMENT URETHRAL STRICTURE: EXCISION AND END TO END ANASTOMOSIS VS SUBSTITUTION URETHROPLASTY RESIDENTS DEBATE AREMU.O.A SUPERVISING CONSULTANT: PROF AA AJAPE.

2. INTRODUCTION Urethral stricture is an abnormal narrowing in the calibre of the urethral lumen, shortening and loss of distensibility due to spongiofibrosis . The disease process of anterior urethral stricture is different to that in the posterior urethra. Predominantly a male disease , but can occur in females It is a common cause of BOO

3. INTRODUCTION 1:10,000 in young adults; 1:1000 in older patients >65yrs (US and UK). Aetiology Varies with the level of development of the environment. Urethritis in developing countries, trauma in developed nations.

4. INTRODUCTION Trauma is now the leading cause in Nigeria- LUTH -72.3%( Tijani KH, Adesanya AA, Ogo CN. Niger Postgrad med. J 2009:16(2);162-5) UBTH-55.9% ( Oguike TC et al , journal of medicine and biomedical research 2006:5(2) NAUTH .Infection-48.5%, trauma 51.6%, iatrogenic- 1.6%( Nwofor A.M.E , Ugezu A.I . African journal of urology 2004;10(2);107-111)

5. Diagram showing the different parts of the male urethral .

6. BLOOD SUPPLY Prostatic branches of inferior vesical and middle rectal arteries Branches of internal pudendal artery(from anterior truck of internal iliac artery) Follows the arteries and have same name Internal pudendal veins(drains to internal iliac veins)

7. INNERVATION Proximal part Branches of pudendal nerves(from the sacral nerves S2-S4) Also derived from prostatic plexus(arises from the inferior portion of the pelvic plexus) Distal part Same as above.

8. CLASSIFICATION Based on patency- Partial/complete Based on length Short segment Long segment Based on complexity Simple Complex (dense spongiofibrosis , multiple etc ) Complicated (fistulae) Based on number -Single/multiple Based on location and anatomy Posterior urethral (PFUDD or post radical prostatectomy-not stricture in real sense) Anterior urethral- navicular fossa, penile, bulbar

9. Management options Short segment Urethral dilation Urethral stenting Laser Internal urethrotomy Anastomotic urethroplasty Substitution urethroplasty Graft Flaps Grafts- oral mucosa, bladder mucosa, full thickness skin grafts, recta mucosa Flaps- Quartey’s , Duckett’s , Orandi , mcAninch , Q flap etc

10. Why is substitution urethropasty better?

11. SURGICAL OUTCOME An estimated prevalence of 296 to 627 per 100000 men male urethral stricture disease imposes a significant burden on health care system Urethroplasty has demonstrated durable high success rate in the management of a wide spectrum of stricture disease. Jordan et al reported a success rate of substitution urethroplasty and excision and primary anastomosis urethroplasty as 93.8% and 90.4% respectively. over all effect of urethral transecting with effect on sexual health and comparable success rate led some center advocating for substitution urethroplasty likely contributing to increase in this procedure.

12. SURGICAL COMPLICATIONS Surgical complication following urethroplasty varies from each locality,it could be low as 2.6% and high 24% reported by barbagli et al. In a multicentre ramdomised study of bulbar urethroplasty comparing excision and primary anastomosis versus buccal mucosa grafting done by ole jacob et al reported 26% and 3.5% respectively Co m pli cations could includ e erec t ile dysfuntion,penile shortening,bleeding, UTI etc

13. RECURRENT RATE Although recurrent rate following urethroplasty varies, depends on surgical technique,location of stricture and degree of stricture. Ole jacob e t al reported recurrent rate 12month post urethropasty between primary anastomosis and substitution urethroplasty as 13%

14. Others Cost implication Psychology feeling Good learning avenue for surgeon .

15. CLOSING REMARKS Dear listener and judges, utilizing subtitution urethroplasty in treatment of short segement urethral stricture will reduce morbidity associate with excision and end to end anastomosis urethroplasty . Patients should be aware of various option of treatment and implication.