Kulkarni reconstructive Urology Center

Effective retraction and clear exposure of urethral tissue is essential in reconstructive penile surgery. The Joshi-Kulkarni retractor provides stable, bloodless operative exposure via non-traumatic tissue compression at the base of penis. The self-retaining design of this retractor also improves ergonomics thereby reducing surgeon fatigue. In this article, we describe how to do a penile urethroplasty by using the Joshi-Kulkarni penile retractor.

Bulbar urethral ischemic necrosis (BUIN) is an iatrogenic entity resulting from repeated attempts at performing anastomotic urethroplasty for pelvic fracture urethral injuries. Etiologically speaking, BUIN is related to a compromised blood supply of the bulbar urethra, which normally relies on anterograde supply from bulbar arteries and retrograde supply from recurrent branches of dorsal penile arteries, through the glans. At each transection of the bulbar urethra, both the anterograde and retrograde supplies are compromised, increasing the risk of BUIN. Even though this term is widely used among reconstructive urologists, BUIN is orphan of an accepted scientific definition. We aim to report our personal perspective on BUIN, to identify factors associated with its occurrence, and to describe the management options in these patients.

Bulbar urethral ischemic necrosis (BUIN) is an iatrogenic entity resulting from multiple attempts at performing anastomotic urethroplasty for pelvic fracture urethral injuries (PFUI). This is not well defined in the published literature. The aim of this chapter is to create its awareness, strategies to prevent its occurrence and management options in established cases of BUIN.

Posterior Urethral injuries after Pelvic Fracture are one of the most devastating and debilitating situations in Urology. It represents a real surgical and decision-making challenge. The adequate initial and late management to this problem with a multidisciplinary approach could avoid many possible urosexual and orthopedic complications, offering the best results to these patients.

Pelvic fracture causes urethral injury in about 10% of patients. The etiology of injury is different in developing and developed world. While high-velocity automobile accidents are common in developed countries, where patients are in the car and there is usually a side impact, in the developing world, significant number of injuries are caused by two-wheeler accidents, pedestrians, farming accidents, fall from height, fall from tractor, fall from tree, and other causes like earthquake. We share our experience which is the largest in the reported literature. In our tertiary referral center, we get referrals from all across the globe. Since 1995 till 2018 we have performed 1307 surgeries for Pelvic fracture urethral injury. Our referrals are for complex urethroplasty. Our data from 1995-2018 was analyzed. Data after June 2018 was not included so as to have a minimum follow up of 6 months. 1296 patients were males and 11 were females. In the group of 1296 males, mean age was 32.4years (range 1-79years). The minimum follow-up was 6months, and the median follow-up was 56.7months (range 6.2-233.7). The overall success rate was 88.79% for primary cases while re-do urethroplasty patients had a success rate of 83.70%. The majority of our patients (more than 61.40%) needed inferior pubectomy: Of the total 1307 cases of urethroplasty for pelvic fracture urethral injury data was available for 1042 patients. Data were available for 1042 patients. The data from 2012 onwards were prospectively analyzed while the previous data were retrospectively analyzed. PFUI are common in the developing world. They tend to be more complex and have longer gaps as compared to developed world. This could be related to the anthropometric differences between races as well as nature of injury. They are best managed with delayed transperineal repair with excellent outcomes. Ancillary maneuvers are more frequently required. Re-do urethroplasty can achieve good results.

Urethral stricture disease continues to be a prevalent condition with significant morbidity. Oral mucosal graft augmentation urethroplasty for long segment bulbar urethral strictures is an established management option. Here the authors outline the results of their pilot study designed to evaluate the efficacy of using two innovative steps for graft augmentation.

Anterior urethral strictures include penile, bulbar and panurethral strictures. In the literature various techniques have been mentioned for their management from single stage to two-stage approach. There are no guidelines concerning the use of dorsal or ventral approaches in bulbar urethroplasty. We share our simplified algorithm for the management of anterior urethral strictures. This algorithm is based on the last three decades of experience in urethroplasty and surgeries all around the globe.