Can distal penile urethroplasty be done using EPA technique?
Patient's Query
Hello doctor,
May I know if you have done urethroplasty in the distal penile urethra using the excision and primary anastomosis (EPA) technique? Are you personally familiar with any such case? If so, was the surgery successful? Did the surgery cause penile curvature? If so, how many degrees did it had? What was the stricture length? Thanks.
Hi,
Welcome to icliniq.com.
I am a Urologist and I have performed urethroplasties. But, excision and primary anastomosis is the procedure of choice only in short segment urethral strictures and they occur in the majority of traumatic urethral strictures that occur in the proximal urethra. Such a stricture in distal urethra is rare. However, I had to do excision and primary anastomosis in an iatrogenic distal penile urethral injury, wherein the surgeon had badly damaged distal penile urethra during an attempt to dilate the distal urethra. I was called intraoperative. The urethral plate was badly damaged in that case for only 0.39 inch. I did excise that part and anastomosed end to end and the result was excellent and there was no postoperative chordee (bending). Other than this case, I have not done any EPA in distal urethra.
Patient's Query
Thank you very much for a very good and detailed answer.
Just to clarify, in that one case, you described where you have done EPA in the distal penile urethra. Was it a simple and straightforward EPA, or have you also done special maneuvers like mobilizing and advancing the bulbar urethra? What was the distance of that stricture from the penis tip in inches?
Hi,
Welcome back to icliniq.com.
The stricture was 0.98 inch from the tip of the penis and it was about 0.29 inch in size with the total disruption for that length. I had to dissect urethra proximally up to the bulb and then urethra was mobilized from the spongiosum to enable a tension free anastomosis.
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