Mobilization of the distal bulbar urethra to the base of the penis can provide 4 to 5 cm of length. The inherent elasticity of the urethra provides a tension-free, spatulated, overlap anastomosis over defects between 2 and 2.5

cm.22 In defects of up to 8 cm in length, the progression approach may be used.31 This method involves performing up to three maneuvers to allow a tension-free anastomosis: (1) midline division of the proximal corporal bodies; (2) inferior pubectomy; (3) rerouting of the bulbar urethra supra-corporally. This approach may also be used Inhibitors,research,lifescience,medical in salvage repairs of failed anastomosis. Conditions preventing the success of delayed or salvage urethroplasty include: (1) defect >7 cm (may require interposition flap); (2) fistulae; (3) anterior urethral stricture Inhibitors,research,lifescience,medical causing reduced blood supply to bulbar urethra; (4) incontinence via external sphincter damage and/or bladder neck damage. Restricture rates after delayed anastomotic urethroplasty are less than 10% and the risk of impotence is 5%.1 It is rare for a stricture to develop more than 6 months after a delayed urethroplasty.20 Complications Complications after blunt urethral trauma are common, but they may also be a result of associated traumatic injuries. Therefore,

it is important Inhibitors,research,lifescience,medical to try to limit their occurrence. Stricture. Strictures can have serious implications to a patient’s quality of life. There is sometimes a need for multiple procedures and recognizing those cases at highest risk is valuable. Partial injuries heal well; in some cases normal urethral voiding without stricture may be seen.32 It has been shown in animal models that even when urethral ends are well opposed, mucosal healing does not occur and the defect is replaced with fibrous tissue instead.33 When a distraction injury Inhibitors,research,lifescience,medical is left to heal and delayed urethroplasty is undertaken at Inhibitors,research,lifescience,medical a later date, the urethral ends are not fibrotic. Fibrous tissue fills the gaps between the two ends, but the urethra is not in continuity. This may explain why anastomotic urethroplasty in these patients commonly heals without stricture. Strictures that are short and flimsy may be treated with optical urethrotomy or dilatation.

Rolziracetam Endoscopic procedures to achieve urethral continuity are appropriate in patients who have short strictures, mild distraction injuries, and a competent bladder neck. Previously described as an endoscopic urethrotomy-to-sound technique, with the advent of flexible endoscopy “cut to the light” procedures are being used increasingly. However, these patients have high rates of reoperation (80%).1 Dense, longer strictures of the anterior urethra should not be repaired with anastomotic urethroplasty as chordee may form. These patients should undergo a substitution (check details either flap or graft) urethroplasty instead. Referral to an appropriately experienced urologist is vital in the management of these complex injuries. Infection and Hematoma.