Preoperative Diagnosis: Urethral meatal stricture

Postoperative Diagnosis: Same

Procedure Performed: Cystoscopy with meatotomy

Indications for Procedure: The patient is a 10-year-old boy with a history of dysuria and misdirected urinary stream. Examination revealed a tight meatal stenosis.

Description of Procedure: The patient was placed in lithotomy position after spinal anesthesia was induced. The operative site was prepped and draped in the usual sterile fashion. A straight clamp was placed into the meatus, clamped ventrally just distal to the corona and left in place approximately 2 minutes. Upon release the crushed portion of meatal tissue was incised with scissors. There was minimal bleeding.

Next a #10-French cystoscope was inserted into the urethra. The entire urethra was unremarkable. The verumontanum was unremarkable and I saw no evidence of posterior urethral valves. The bladder neck was traversed with the scope and the bladder examined. There was no evidence of stones, diverticula, tumors or foreign bodies. The ureteral orifices were on the trigonal ridge and were normal in size, and shape. Bladder mucosa was entirely normal in appearance. The bladder was drained of irrigating solution, cystoscope was removed and the procedure terminated.

The patient tolerated the procedure well and was returned to the ambulatory surgery recovery area in stable condition.

  

Preoperative Diagnosis: Stress urinary incontinence due to intrinsic sphincter deficiency

Postoperative Diagnosis: Same

Operative Procedure: Laparoscopic bladder neck suspension

Description of Procedure: The patient was placed in the supine position on the OR table after administration of general anesthesia. The surgical sites on the perineum and abdomen were prepped and draped in the usual sterile fashion and the patient was placed in lithotomy stirrups.

An infraumbilical incision was made just lateral to the midline. The anterior rectus sheath was opened and stay sutures were placed at either end of the incision. The muscle was retracted with two S-shaped retractors and the posterior sheath identified. Now using blunt digital dissection a space was created to the symphysis. The retropubic space was identified and entered. The dissection balloon was inflated and under direct vision the retropubic space was developed. This was removed and a retraction balloon placed and inflated. No abnormalities were seen upon careful inspection. All appropriate landmarks were identified, that is, the symphysis, Cooper's ligament, pubic bone, bladder neck and epigastric vessels.

Next the paravaginal fascia was cleared lateral to the bladder neck. The surgeon's left index finger was placed in the vaginal vault to assist with dissection and placement. Cooper's ligament was exposed bilaterally. The mesh was cut to 1 x 2 inches and placed through the lateral 5-mm port. The mesh was placed at the level of the bladder neck and then subsequently tacked to Cooper's ligament after elevation of the bladder neck. The mesh was placed on the contralateral side in a similar fashion. Excellent bladder neck elevation was achieved. The Foley catheter was draining clear urine.

The 5-mm lateral trocars were removed and no bleeding was noted from either port. The balloon was deflated and removed and CO2 was evacuated from the retroperitoneal space. The rectus port was closed with a running 2-0 Vicryl. Skin margins of all incisions were closed with a subcuticular 4-0 Vicryl. Steri-Strips, Telfa and Tegaderm were placed over the incisions. The patient tolerated the procedure well and was taken to the Recovery Room in stable condition.