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The patient’s were positioned in a simple lithotomy position. The patient’s calves are safely placed in Allen stirrups by sequential inflatable compression sleeves, and the lower extremities were then balanced by the patient’s feet in the boots of the stirrups.
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Proper positioning will make sure that there will be no pressure on any aspect of calf muscles and no inward boot rotation to avoid perineal injury of nerve.
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The skin of the perineum, suprapubic region and scrotum was shaved completely, and this region is draped and prepared appropriately with Methylene blue and injected into the urethra for better define of the urethral mucosa.
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A midline perineal cut is done. The bulbospongiosum muscles was divided from the corpus spongiosum of the bulbar urethra by using smooth, delicate scissors, leaving the lateral margins of muscle and the central tendon of perineum intact.
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Then the muscle was dragged down by using 2 tiny Farabeuf retractors, and the ventral urethral surface which are exposed completely.
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The distal extent of the stenosis was detected, the corpus spongiosum were incised or cut along the ventral midline, and the urethral lumen was exposed completely.
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Then the stricture was incised with its total length by extending the urethrotomy proximally and distally.
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Once the whole stricture was been incised or cut, the width and length of the left over urethral plate were measured. The oral mucosal graft was trimmed to its exact size based on the width and length of the urethrotomy.
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The 2 ends of the graft were sutured to the distal and proximal apices of urethrotomy, and running 6-0 polyglactin suture were used to do a watertight anastomosis among the left margin of the graft and urethral mucosal plate.
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A Foley 16-French ridged silicone catheter was inserted. The graft was rotated over the catheter, and running 6-0 polyglactin suture were used to do a watertight anastomosis in among the right margin of the graft and mucosal urethral plate.
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After graft suturing was done, the corpus spongiosum was closed over the graft with the help of 2 ml of fibrin glue is injected above the corpus spongiosum and 4-0 polyglactin interrupted suture. The bulbospongiosum muscle was picked up to cover spongiosum tissue.
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The perineal fat, Colles’ fascia, and the skin were closed with interrupted absorbable sutures. The catheter will be left inside in same place for 3 wk.
