PFUDD Santucci

SANTUCCI PFUDD anastomosis 

Preop:

  • SP tube present? Change 3 days prior to surgery and make sure pt on covering abx
  • Remove SP tube in OR before prepping
  • Position: high lithotomy; must make sure butt towards edge of bed
  • Shave perineum and scrotum
  • Male sounds
  • Pickups with teeth
  • Numbered (“1-12” for arms of clock) snaps
  • Double armed 5-0 PDS x 12

 

Procedure:

  1. Midline perineal incision.
  2. Identify bulbospongiosus muscle and split in midline with mets.
  3. Identify corpus spongiosum and dissect around circumferentially with mets and traction.
  4. NOTE: helpful to put penrose/finger around spongiosum.
  5. Must free spongiosum to penoscrotal junction; must do to assure proper apposition later.
  6. Dissect sponge as proximally as possible; be wary of bulbar areteries (save both or even one of them if possible).
  7. Place 24F male sound thru SP tract to expose posterior urethra (membranoprostatic); palpate where tip is in wound.
  8. Transect distal bulbar urethra thru scar; urethra should be free now.
  9. Tuck urethra away into scrotum with raytec to facilitate posterior dissection.
  10. Scar = any tissue anterior to tip of sound and posterior to where bulbar urethral was transected.
  11. Scar needs to be excised: perform with scissors or scalpel long handle.
  12. Tip of sound should be seen; keep cutting scar until healthy mucosa tissue is seen
  13. NOTE: must dissect around proximal urethra to facilitate stitch placement later; do sharply.
  14. Place 5-0 PDS at 1-12 o’clock thru exposed proximal stump; snap with appropriately numbered snap (note: “12” is the most dorsal part of the proximal urethra).
  15. Do this 10-12 times depending on size of lumen.
  16. Untuck bulbar urethra, transect further scar if present, and spatulate ventrally (on top); 12 o’clock proximal urethral suture should go thru 6 o’clock portion (dorsal portion) of the bulbar urethra.
  17. Do this 10-12 times.
  18. Place urethral catheter 16F and make sure not tangled. Suck out urine.
  19. Pull urethra down to proximal urethral opening and tie the sutures starting with the posterior sutures first.
  20. Close wound in multiple layers running: 3-0 vicryl for muscle, 2-0 vicryl for superficial tissue and colle’s fascia
  21. Close skin interrupted 2-0 chromic suture
  22. Floseal as needed
  23. 0.5% marcaine to wound.
  24. Place SP tube 18F.
  25. Foley and SP tube to bag drainage.

 

Postop:

  • Admit 3-4 days
  • VCUG in 2 weeks
  • Nitrofuratoin daily after 24 hr amp gent periop abx prophylaxis

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