Operative Procedure

The skin and superficial fascia is divided. The penis is mobilized and the deep dorsal vein and neurovascular bundle ligated and divided. The suspensory ligament is divided and the dissection continues proximally.

A separate inverted U incision is made in the perineum for the creation of a perineal urethrostomy (Fig. 7.12). Following the division of the superficial fascial layers and splitting of the bulbospongiosus muscles, the urethra is identified and mobilized. Ensuring that there is an adequate urethral length, the urethra is transected and spatulated ventrally (6 o'clock position) in order to allow the tip of the U to be incorporated ventrally. The crura are followed down to the level of the pubic bone and a periosteal elevator is used to completely divide the crura off the pubic bone. The dorsal artery is present at this point and requires identification and ligation.

For the subtotal procedure, the crura are transected after gaining proximal control using vascular clamps. The crura are then oversewn using 2/0 NAS. The skin is then sutured to the urethra using 3/0 and 4/0 sutures.

A 14Ch Foley catheter is left in situ and removed after 1 week to 10 days. Antibiotics are continued for 1 week. A drain is left in the perineum and also the pubic area. A pressure dressing is applied to reduce hematoma formation.

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