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Figure 3
Step 4. If you are performing this procedure
on your own, after initial dissection it helps
to place a self-retaining retractor by using
either a Lone Star retractor or several pediat-
ric Gelpi retractors. With proper retraction, the paired
ischiourethralis muscles can be palpated, inserting
on the ischium on either side of the penis (Figure 3).
Isolate these muscles and either elevate them off the
bone by using a periosteal elevator or scalpel blade or
simply transect them with electrocautery to minimise
hemorrhage.
4
Figure 5
Step 5. Next, pull the penis dorsally to apply
tension on the penis’ ventral ligament, and
transect this ligament by using tenotomy
scissors Figure 4.
5
Continue ventral dissection until you can pass a finger
without resistance into the pelvic canal in this region
as well (Figure 5). Perform final dissection dorsally, but
do so with more caution as this is where the urethral
blood supply and innervation are located.
Step 6. When the penis is completely mobi-
lized, locate the bulbourethral glands (poorly
developed in castrated males). Dissect the re-
tractor penis muscle from the dorsal aspect
of the penis, transect it proximally and remove it to
expose the urethra on the dorsal surface of the penis.
6
Figure 4
You’ll know you’ve achieved complete transection
if you can pass a finger lateral to the penis and into
the pelvic canal without resistance. Repeat this on the
contralateral side.
Figure 6
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