Editing Penis and Urethra Surgery (section)

====== Technique ======

*The best results are achieved when the following technical points are observed:
** The area of fibrosis is totally excised
** Urethral anastomosis is widely spatulated, creating a large ovoid anastomosis
** Anastomosis is tension free
* '''<span style="color:#ff0000">Position: lithotomy'''
*'''Steps to gain urethral length:'''
*# '''Vigorous mobilization of the corpus spongiosum'''
*# '''Development of the intracrural space and detachment of the bulbospongiosus from the perineal body'''
* '''When the length of stricture precludes total excision of fibrosis with primary anastomosis, tissue transfer in the form of graft or flap is required.'''
** '''Tubularized grafts and skin islands should be avoided, if possible.'''
*** Onlay procedures (graft or flap) are associated with a higher success rate than tubularized grafts or tubularized skin islands.
** '''Excision with primary anastamosis should be avoided in patients with a history of hypospadias repair due to expected altered or absent retrograde blood supply to the urethra through the normal arborization in the glans'''
* It is imperative to evaluate the urethra completely proximal and distal to the stricture with endoscopy and bougienage during surgery to ensure that all the involved urethra is included in the reconstruction.