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Dr (Col) H S Bhatyal
Urologist,
Lions Kidney Hospital
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INTRODUCTION
Management of traumatic obliterative posterior urethral strictures
remains a surgical challenge. Core through optical urethrotomy
has established its credibility in selected cases (1,2,3).The
most pertinent technical issue in Core through Urethrotomy
is suprapubic guidance, because unlike non-obliterated strictures
there is no lumen to guide the incision. Various methods have
been described in literature varying in complexity from simple
suprapubic metal sound, lighted cystoscope, needle- guidewire
perforation to fluoroscopic guidance. But the potential hazards
of false passage, extravasation and rectal injuries are always
there. We have used Core Through Urethrotomy guide (CTU- Guide)
as a pathfinder to negate the hazards and make Core Through
Urethrotomy easy and precise.
METHOD
CTU guide is a modified hollow metal bougie with a sharp ended
metallic obturator which projects out (1.5cms) off the distal
end under controlled manner (Fig. 1&2). Urethrotome is
passed per urethra and the CTU Guide ispositioned into the
posterior urethra suprapubically.
Obturator is pushed by the assistant
in controlled manner and the sharp end pierces through the
scar tissue towards the Urethrotome. The sharp metallic tip
can be easily identified and followed into the bladder. If
required, this obturator can be replaced by another hollow
obturator carrying a ureteric catheter (Fig. 3 & 4) which
can further guide to carry out urethrotomy. After successful
core through Urethrotomy, a Foley's Catheter 18/20 F is indwelled.
ADVANTAGES
By using CTU Guided as a pathfinder, Core through Urethrotomy
is accomplished faster, chances of extravasation and false
passages are eliminated and rectal injuries are avoided. There
are no difficulties encountered in mastering the point of
technique by using this most versatile instrument. The instrument
is economical and has proved to be a valuable addition to
the armamentarium of the surgeons and Urologists practicing
Core Through Urethrotomy.
REFERENCES
| 1. |
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Goel M C, Kumar M, Kapoor R. Endoscopic management of
traumatic posterior urethral stricture; early results
and follow up.
J. Urol 1997: 157:95-7. |
| 2. |
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EL–Abd SA. Endoscopic treatment of post-traumatic
urethral obliteration; experience in 396 patients.
J. Urol 1995: 153:67-71. |
| 3. |
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Gupta N P, GILL I.S. Core through optical internal urethrotomy
in management of impassable traumatic posterior urethral
stricture.
J. Urol 1986: 136:1018-21. |
Dr. Bhatyal's name has been
included in “Limca Book of Records” for his innovation
in Urology.
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EVENT
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