PFUDD Santucci
SANTUCCI PFUDD anastomosis
Preop:
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SP tube present? Change 3 days prior to surgery and make sure pt on covering abx
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Remove SP tube in OR before prepping
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Position: high lithotomy; must make sure butt towards edge of bed
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Shave perineum and scrotum
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Male sounds
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Pickups with teeth
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Numbered (“1-12” for arms of clock) snaps
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Double armed 5-0 PDS x 12
Procedure:
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Midline perineal incision.
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Identify bulbospongiosus muscle and split in midline with mets.
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Identify corpus spongiosum and dissect around circumferentially with mets and traction.
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NOTE: helpful to put penrose/finger around spongiosum.
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Must free spongiosum to penoscrotal junction; must do to assure proper apposition later.
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Dissect sponge as proximally as possible; be wary of bulbar areteries (save both or even one of them if possible).
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Place 24F male sound thru SP tract to expose posterior urethra (membranoprostatic); palpate where tip is in wound.
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Transect distal bulbar urethra thru scar; urethra should be free now.
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Tuck urethra away into scrotum with raytec to facilitate posterior dissection.
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Scar = any tissue anterior to tip of sound and posterior to where bulbar urethral was transected.
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Scar needs to be excised: perform with scissors or scalpel long handle.
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Tip of sound should be seen; keep cutting scar until healthy mucosa tissue is seen
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NOTE: must dissect around proximal urethra to facilitate stitch placement later; do sharply.
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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).
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Do this 10-12 times depending on size of lumen.
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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.
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Do this 10-12 times.
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Place urethral catheter 16F and make sure not tangled. Suck out urine.
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Pull urethra down to proximal urethral opening and tie the sutures starting with the posterior sutures first.
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Close wound in multiple layers running: 3-0 vicryl for muscle, 2-0 vicryl for superficial tissue and colle’s fascia
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Close skin interrupted 2-0 chromic suture
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Floseal as needed
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0.5% marcaine to wound.
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Place SP tube 18F.
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Foley and SP tube to bag drainage.
Postop:
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Admit 3-4 days
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VCUG in 2 weeks
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Nitrofuratoin daily after 24 hr amp gent periop abx prophylaxis
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