Posted by C S Loh on June 16, 1999 at 01:57:12:
In Reply to: Re: Posterior urethroplasty posted by CLDing on June 15, 1999 at 14:45:32:
Dreadful is right! And he is a doctor's relative! My theory is the same as yours. I find it hard to believe that there is inadequate blood supply. Tony Mundy taught me to apply a soft bowel clamp on the devided urethra to stop the bleeding form the cut end as the urethra has a very rich blood supply from both ends. He is a fairly well controlled NIDDM but did have a UTI which also infected the suprapubic wound (I made to passed a sound down from above - he was on a 10Ch Cystofix for 3 months!). One other possibility was that this was the damage caused by the clamp but in fact the necrosis extended all the way to whole mobilised length of urethra and not just to where I clamp the urethra. I buy the infection theory and his diabetes certainly did not help! Interestingly, he did not have a fever. As he was discharging pus and urine perineally, I opened him up and excised all the dead tissue - yes, truly dead - and left the wound open to granulate. He had been circumcised and there was really no hairless genital skin nearby. I am going in tomorrow to lay some skin on. It is a large area and I doubt if I can get enough buccal mucosa. So I am planning to use post-auricular Wolfe graft. Wish me luck!