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The patient was intubated through the nose, by allowing the mouth to be free completely.
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The patient was operated by 2 surgical teams work concurrently, each are having its own set of surgical instruments. The oral mucosa graft was harvested from the cheek according to the normal standard technique used.
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The graft was tailored according to the characteristics and length of the stricture. The patient was positioned in a simple supine position.
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A suture was placed into the glans to stretch the penis. Before starting the urethra reconstruction the new meatus was again calibrated by the progressive insertion of 10, 12, 14, & 16 F Nelaton catheters.
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If the new meatus was well calibrated to 16 F, they will begin the second stage. If the meatus won’t accept the 16 F Nelaton catheter, they will do meatotomy & the second stage reconstruction was delayed for 6 more months.
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The lateral skin cut or incisions & the midline incision of the urethral plate were outlined. The urethral plate was fully longitudinally cut or incised & was opened. 2 ml of the glue was injected onto the window of the urethral plate. The graft was moved over the glue bed & pressed by using 2 small swabs for 45 s.
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The graft was fixed by 2 6/0 polyglactin stitches on the extremities of the urethral plate cut or incision & the lateral margins of the penile skin were incised. A Foley 12 F silicone grooved catheter was inserted. The urethra was closed in a single layer over it by using 5/0 polyglactin sutures & the dartos fascia was closed over the suture line. The penile skin was closed meticulously & a soft dressing was applied.
POSTOPERATIVE COURSE AND FOLLOW-UP:
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Ice-bags were placed on the cheek & genital area for 24 h to decrease the pain & hematoma formation.
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Patients were discharged from the hospital after 3 days the surgery was done and voiding cystourethrography was done 2 weeks later.
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The clinical result will be considered as a failure when any of the postoperative instrumentation were required, including the dilation.
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Uroflowmetry & urine cultures needs to be repeat for every 4 months in the first year & annually after that. When the symptoms of decreased force of the stream are present & uroflowmetry will be less than 14 ml per second, the urethroscophy, urethrography and urethral ultrasound are repeated.
