Problems of the urethra. Surgical approaches.

The urethra is the normal conduit for evacuation of urine from the bladder to the exterior. The integrity of urethral anatomy and function is a prerequisite to normal micturition. Abnormalities that develop within or around the urethra, traumatic injuries of the urethra, and attempts to correct these abnormalities surgically may have detrimental affects on urethral architecture and function. They may ultimately result in urethral obstruction or extravasation of urine in periurethral tissue, the pelvic cavity, and, in some instances, the peritoneal cavity. Urethral surgery is often hampered by difficult exposure, the close proximity of vital neurovascular anatomy, and by the detrimental affects urine has on wound healing and hemostasis. Iatrogenic urethral injury may occur when surgical dissection near the urethra must be done. Successful management of urethral abnormalities requires knowledge of urethral surgery and its pitfalls. Anticipation of the development of urethral problems and the determination of the necessity of surgical intervention is the author's goal.