Urology Video Journal (Mar 2023)
Single stage management of panurethral stricture
Abstract
Objective: The Kulkarni Technique of one-sided dissection with penile invagination allows for single-stage management of panurethral stricture. In this accompanying video, we demonstrate and discuss the use of this technique in urethral reconstruction. Patient and surgical procedure: The patient is a 60-year-old male with a history of stricture treated in the remote past with posterior auricular graft. His-stricture eventually recurred, and he was self-calibrating weekly for 15 years before presenting to us with obstructive lower urinary tract symptoms and recurrent urinary tract infections. Investigation with urethrography revealed an approximately 10 cm urethral stricture extending from the proximal bulbar urethra to mid-penile urethra. No evidence of lichen sclerosus was evident on physical examination.A perineal incision was made, and one-sided dissection carried out on the patient's left-side, dividing the bulbocavernosus muscle to access the urethra dorsally. This dissection was extended towards midline to rotate the urethra off to one side, leaving the right-side neurovascular attachments intact. Once the penis was invaginated, the dissection was extended proximally and distally beyond the extents of the urethral stricture.The urethra was then opened dorsally through the length of stricture and two oral mucosa grafts were quilted onto the adjacent tunica albuginea. The urethral edges are then sewn to the edges of the graft, de-rotating the urethra back into its orthotopic position. A catheter is inserted prior to completion of this urethral closure. The bulbocavernosus muscle edges are reapproximated and the bulbar incision is closed in multiple layers. Results: This patient had an uneventful recovery and a peri‑catheter urethrogram approximately 3 weeks after surgery demonstrated no extravasation, so the catheter was removed. The patient continues to do well with no evidence of recurrence at 3 years follow-up. Previously reported outcomes suggest this is a safe, reproducible, and durably effective technique. Conclusion: The Kulkarni Technique offers a minimally invasive, single stage approach to pan-urethral stricture. It allows for avoidance of a penile incision and minimization of impact on the neurovascular support structures of the anterior urethra.
