The surgical method for upper urethral fissure is relatively simple and suitable for patients with upper urethral fissure accompanied by urinary incontinence; Or partial completeness urinary incontinence is invalid after exercising pelvic floor muscles and urination training.
1、 Preoperative preparation
Patients with urinary tract infections should be controlled before undergoing surgery. Other preoperative preparations are the same as those for hypospadias surgery.
2、 Anesthesia and Posture
Children can use general anesthesia, while children or adults can choose spinal anesthesia and epidural block anesthesia. Take a flat lying position.
3、 Surgical steps
1. Remove the median abdominal incision and expose the anterior wall of the bladder.
2. Fully free the bladder neck, anterior and lateral walls of the posterior urethra within the posterior pubic space, directly reaching the urogenital diaphragm.
3. Cut the anterior wall of the bladder longitudinally, downward until it is slightly below the plane of the ureteral opening, and then cut horizontally towards the bladder walls on both sides. Cut off the bladder neck, anterior wall of the posterior urethra, and a portion of the lateral wall through the lateral wall of the bladder to the outer edge of the triangle area. The bladder neck and posterior wall of the posterior urethra form a smooth muscle strip.
4. The smooth muscle strips formed after cutting, surrounding F12~F14 catheter, are continuously or intermittently sutured with No. 3-0 catgut to form muscle tubes, forming a thin and long tube than the original bladder neck and posterior urethra. Intermittent suturing of the muscle layer with No.0 silk thread for reinforcement.
5. Upper pubic cystostomy, bladder with built-in cystostomy tube, closure of bladder with No. 2-0 intestinal suture, drainage of a cigarette after pubic bone, layer by layer closure of incision.
(Intern Editor: Cai Junyi)