Neourethra: A New Two-Stage Procedure for Reconstruction of the Functional Urethra

Abstract

In 14 male dogs, the functional urethra was replaced by a bladder flap tube in a 2-stage procedure. In the 1st stage of the operation a bipedicle strip from the anterior bladder wall was tubularized around a 10F or 12F catheter. After 10 to 12 weeks the 2nd stage of the procedure was performed: the bladder neck was transected and sutured, and the cranial pedicle of the bipedicle tube was transected and pulled through the bluntly dissected pelvic floor muscles. From the distal end of the tube a perineal urostoma was created to facilitate radiological and urodynamic followup. Eight dogs completed a followup 5 months after the 2nd procedure. Urodynamic and x-ray studies were done preoperatively, after the 1st, and twice after the 2nd operation. All dogs were continent as a result of a mean functional urethral length of 8 cm. with a maximum closure pressure of 82.9 cm. H2O. Closure pressure was related to the tone of the smooth muscular tube and additional compression of the tube by the pelvic floor muscles. The method is considered to be applicable in cases of congenital defects or total loss of the functional urethra.

Fascial Sling for Treatment of Urinary Incontinence in Males

“…This was achieved by comparing recordings from the intact urinary tract and a non-contractile urethral Substitute being anastomosed to the bladder neck and pulled through the pelvic floor to eliminate all contributions of the intrinsic urethral muscles. The use of an acontractile Substitute Urethra eliminated nearly completely the basal tone of the Urethra, an effect which does not occur if a tubulär bladder flap is used as a neourethra (1,10,11,12,27,28,30,32).…”

Die Harninkontinenz des Mannes. Faszienzügelplastik zur Therapie der Streßinkontinenz

“…Demnach erlaubt das Modell die isolierte Betrachtung des Effektes der periurethralen Beckenbodenmuskulatur unter Streßbedingungen auf die Harnröhre. Die Ausschaltung des intrinsischen Urethratonus durch Verwendung des nicht-kontraktilen Harnröhrenersatzes dokumentierte sich in einem weitgehenden Verlust des Urethraruhetonus, der nicht auftritt, wenn eine Neourethra aus einem tubulär umgeformten Blasenlappen gebildet wird (1,28,30,31,60,64,68,76).…”