Urethral operations

Classification and localization of injuries

In clinical practice, injuries of the urethra are generally divided into two main groups. The first includes closed injuries in which the integrity of the external integument remains preserved. The second group comprises open injuries, accompanied by obligatory disruption of the structure of the surrounding soft tissues.

From the standpoint of topographical anatomy, ruptures can be localized in various segments. The spongy part of the canal (pars spongiosa) is most frequently affected. Injuries are also distinguished in the area of the posterior urethra, which includes the membranous and prostatic parts (pars membranacea et prostatica). The exact localization of the injury determines the subsequent surgical approach and the choice of operative tactics.

Basic surgical technique for urethral rupture

The main goal of surgical intervention in trauma is to restore the anatomical continuity of the tube. The operation begins with the insertion of a catheter, which acts as a reliable internal landmark and is advanced precisely to the site of injury.

The next critical step is wound revision. The surgeon must completely remove the periurethral hematoma. Only after clearing the tissues of blood clots does adequate exposure of the ruptured ends of the urethra become possible.

Suturing the canal requires meticulous precision. First, the initial two guiding sutures are placed at the edges of the rupture. After this, the previously inserted catheter is advanced further, past the damage zone. All remaining sutures are placed strictly over the catheter, which serves as a rigid scaffold and prevents luminal narrowing. An important rule: for the entire healing period and until the patency of the canal is fully restored, urine is diverted exclusively through a suprapubic urinary bladder fistula (epicystostomy).

Surgical treatment of strictures: from bougienage to meatotomy

Strictures (pathological narrowing) of the urethra require a staged approach. The simplest method of restoring the lumen is bougienage — gradual mechanical dilation of the canal using special instruments.

If the narrowing is localized in the area of the external orifice, a meatotomy (incision) is performed. The key rule of this operation: the incision is always made strictly in the direction of the inferior wall of the urethra. To prevent recurrent scarring, daily bougienage is prescribed for the patient in the postoperative period.

Radical surgeries for strictures: Marion-Holtsov and Solovov methods

In cases of pronounced cicatricial changes, resection is used. The Marion-Holtsov method is indicated for strictures of the bulbar part. The operation is always initiated with prior placement of a suprapubic fistula. Then, retrogradely (against the urine flow), a metal catheter is introduced into the canal, advancing it to the stricture zone.

The surgeon makes an incision along the midline of the perineum, exposes the bulbar segment, and completely excises the scarred area. The ends of the urethra are sutured end-to-end with interrupted catgut sutures over a catheter. The perineal wound is closed in layers with mandatory placement of a drain.

The Solovov operation is used for deeper strictures — in the membranous and prostatic parts. Its essence lies in invagination: the mobilized peripheral segment of the urethra is embedded into the central segment to a depth of 0.5–1.0 cm.

Final stage of plasty and patient management

Any urethral plasty requires proper finalization. Technically, this is expressed by carefully suturing the urethral mucosa to the skin, forming an even edge without tension.

In the postoperative period, to ensure adequate healing and prevent secondary strictures, a catheter is invariably introduced into the urethral lumen, remaining there for the entire tissue recovery period.

Class and exam questions

What else to study on this topic

• Topographical anatomy of the spongy, membranous, and prostatic parts of the urethra.
• Technique for performing an epicystostomy (placement of a suprapubic fistula).
• Types of sutures and suture material used in plasty (catgut).
• Complications following urethroplasty and methods for their prevention.
• Instruments and methodology for performing urethral bougienage.

Other topics in the section «Pelvic and Perineal Surgery»

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.