The ventral approach is more versatile, much easier, quicker, and less aggressive than the dorsal approach. It is easier since it can provides a direct contact to the urethral lumen and a clear view of the stricture, allows the conservation of as much as probable of the urethral plate through the urethral opening. This ease of accessibility is important and evident, particularly in the proximal bulbar tract.
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The treatment is performed under the spinal anesthesia by a centerline perineal cut then the bulbar urethra is been exposed but it is not mobilized.
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The distal extent of stenosis is recognized by a gently insertion of 16-French catheter which is having a soft round tip until it meets resistance.
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A corpus spongiosum is incised in the ventral centerline till the catheter tip and urethral lumen are exposed.
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Then strictures are incised through its complete length by extend of the urethrotomy proximally and distally. Once the complete stricture has been incised, the width and length of the left over urethral plate are measured.
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Calibration of urethra by both proximal and distal with a specially customized nasal speculum is critical for identifying any residual narrowing. The buccal mucosal graft is then trimmed to its suitable size, according to the width and length of the urethrotomy.
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The graft are sutured by their 2 ends to the proximal and distal apices of the urethrotomy and consecutively 6-O polyglactin suture is required to do a watertight anastomosis in between the left margin of the both graft, urethral mucosal plate.
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A Foley 16-Fr grooved silicone catheter was inserted. Then graft is rotate over the catheter and running 6-O polyglactin suture is required to do a watertight anastomosis between the right margin of the both graft and mucosal urethral plate.
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After completion of graft suturing then closing of corpus spongiosum is done over the graft with 4-O polyglactin interrupted suture. The bulbocavernous muscle is re-approximated over the spongiosum tissue and Colles fascia, the perineal fat and the skin were closed with interrupted absorbable sutures. The catheter will be removed after 3 weeks.
