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SURGERY
maximize urethral diameter, but incision beyond this
point will place excessive tension on the stoma when
suturing the perineal skin. When a mosquito haemo-
stat can be passed up to the hinge, the urethral diame-
ter is sufficient and suturing can begin (Figure 7).
Step 8. At this point, remove the retractors
and place initial sutures beginning at the apex
of the urethrostomy (dorsally). I place the su-
tures from inside to out (urethral mucosa to
skin), placing one interrupted suture in the center of
the urethra and the proximal aspect of the incision,
followed by two more interrupted sutures 45 degrees
to the initial suture, spacing about 1 to 2 mm between
sutures (Figure 8). It is helpful to preplace all three of
these sutures to maximize exposure of the mucosa
and achieve perfect placement. Successful apposition
of mucousa to skin is crucial at this point, so use of
magnification is encouraged. If you are in doubt, take
the sutures out and replace them.
8
Figure 7
7
Step 7. Next, carefully incise the urethra at a
distal location with a scalpel blade to make a
small stab incision over the red rubber cath-
eter (Figure 6)
The tissue is thicker than you may initially expect,
and a firm incision is required to penetrate the ure-
thral lumen, exposing the catheter. Extend the ure-
thral incision by inserting the fine tenotomy scissors
into the incision and moving proximally to the level of
the bulbourethral glands. The incision may be extend-
ed about 1 cm cranial to the bulbourethral glands to
Figure 9
Step 9. After placement of these three key su-
tures at the dorsal aspect of the urethrosto-
my, complete the stoma by placing interrupt-
ed sutures spaced 1 to 2 mm apart, creating
a drain board of urethral mucousa. Then lightly ligate
the penis and transect it distally before completing the
stoma (Figure 9).
9
Technique modifications
A few modifications have been developed to achieve
optimal results.
Figure 8
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Issue 02 | APRIL 2017 | 10