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Perineal Urethrostomy - Coggle Diagram
Perineal Urethrostomy
Procedure
Elliptical incision around penis
Break down connective tissue
Pull caudally
Constantly identify penis
Rake scalepel along penis to remove tissue
Do this until you can see penis muscle
Thin retractor penis muscle on dorsal aspect of urethra
Use iris scissors to cut it all the way at the proximal base
Blunt dissect around lateral muscles
Should get a little passage, clamp this muscle
Cut on body side, not penis side
Work on ventral attachement
Fascia band that attaches penis to pubis
Penis should pop dorsally
Incise up the urethra
Start distally, stay on midline
Between bulbourethral glands
Suture skin to urethral mucosa
Dorsal sutures first - fornix of skin to urethra
Then one on either side, ~45 degree angle
there should not be tension to avoid stricture
4-0 or 5-0
remainder of sutures go on the sides
Amputate penis
As distally as possible
Place catheter and drain bladder with 30-60ml saline
Do this until clear
Tips
Keep catheterized
Place a hemostat on distal tip of penis for caudal traction