A -27- old gentleman came with history of weak stream, straining at micturition.There was no history of obvious trauma or prior urological intervention( like catheterization).He did not have the history of exposure also.There was no evidence of Balanitis Xerotica Obliternas on genital skin and mucosa.
He was evaluated and found to be short segment stricture in the proximal bulbar urethra.
He underwent multiple endoscopic interventions and urethral dilatations.
He needed recurrent dilatations. He was advised option of definitive urethroplasty.
He was taken up for ventral onlay urethroplasty.
Under spinal anesthesia through a midline perineal incision the bulbar urethra is exposed without mobilisation. Methylene Blue dye was injected through the meatus. A bougie was passed through the meatus upto the level of the stricture. Ventral urethrotomy is performed through the strictured urethra into normal proximal bulbar urethra upto 1.5cm. Methylene Blue stained urethral mucosa helps to identify the narrowed lumen of the urethra. A 2 cm wide and 6cm long buccal mucosal graft harvested from the cheek and it was defatted.
The BMG is sutured to the urethral mucosa with continuous sutures of 4/0 vicryl to the ventral urethrotomy throughout. A 14 F silastic Foley catheter was inserted to the bladder. The corpora spongiosa was over closed with continuous sutures of 4/0 vicryl and taking anchoring stitches through the buccal mucosa graft. The wound is closed in layers. The catheter is planned to be removed after 4 weeks.