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Re: Anterior Urethral DiverticulumFrom: john miklos (johnrmiklos@yahoo.com)Mon Feb 7 15:40:21 2000
Though I have not corrected any anterior urethral tics, most are found as congenital phenom and are often corrected in pediatric patients. Adult anterior urethral tics can be approached by a couple different methods depending upon the location. Preop evaluation with a voiding cystourethrogram and preferably a Tratner or Davis study (double baloon catheter) would be beneficial to 1)id the location and 2)determine whether the tic is multisacule or there are mulitiple tics. Distal urethral tics whether anterior, lateral or posterior may be treated via a Spence procedure---incising and suturing back the mouth of the urethra (postoperatively the patients often complain of spraying urine) or a transurethral approach. Midurethral or proximal ventral tics can be approached through a laparotomy. Anterior tics can be surgically treated the same way one would treat a posterior urethral tic only the approach should differ. Excision and closure of the tic, remains the same using a delayed absorbable 4-0 or 3.0 sutures. Postop drainage with a suprapubic catheter for 10-14 days would be appropriate. Though not reported to date (that I am aware) This might be a great case for a laparoscopic approach depending on the size and location of the tic. Quite a few reports are available for closure of bladder fistula.
-- john miklos
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