This video demonstrates a surgical procedure to relieve me AAL obstruction. Following circumcision, allowing normal urinary flow and drainage, the child is placed in a supine position and the surgical site is prepped to prevent infection. Next, the hemostat is placed properly to achieve adequate urethral mutal caliber, and the scar tissue is removed.
The scar tissue is then excised with precision using micro scissors. Finally, the mucosal and glandular tissue are re approximated to prevent recurrence. Hi, I'm Dr.Wong.
I'm one the pediatric urologist here at Johns Hopkins. Today we perform procedure term Neal Plasty. The idea behind the procedure is to remove the ventral scar tissue that developed after a neonatal circumcision.
If done properly, the success rate is close to a hundred percent and the cosmetic result is superb Mutal stenosis, an abnormal narrowing of the urethral opening is a common complication after circumcision occurring in nine to 10%of males and resulting in urinary frequency. A routine urine analysis will rule out urinary tract infection or diabetes as potential causes of urinary frequency. The physical exam should include tion confirming the mutal stenosis diagnosis.
The equipment needed for intraoperative preparation includes surgical loop magnification, a mosquito hemostat fine tipped plastic microsurgical scissors, a Castro vijo needle holder, and a seven zero vicryl suture. Now let's see. The surgical procedure Begin by placing the child into a supine position.
Minimally prep the skin and drape the genitalia. No prophylactic antibodies are needed. Use a Betadine povidone iodine solution to scrub the genital region and allow it to remain for approximately three minutes prior to the initial incision drape off the penis with sterile towels.
A right-handed surgeon should stand on the left side of the patient and introduce one jaw of a well lubricated mosquito hemostat into the tip or ventral aspect of the urethral to a depth of approximately two to three millimeters. Now crush the ventral tissue by closing the hemostat. The total clamp time is 60 seconds.
Using microsurgical scissors sharply inci the crushed ventral tissue. Next, use seven zero Vicryl sutures to re approximate the inner urethral mucosa and glandular tissue in an interrupted fashion. So this is probably the most difficult part of the procedure cause you really wanna avert that urethral mucosa out and tie your knots towards the outside of the natus.
And with seven oh sutures, we generally put six knots. This is so fine. All right, so that looks great.
The ADA is nice and open, and you can tell it's still slit like so that's a nice reconstruction. Okay, great. The recovery time is minimal and the child is sent home with Tylenol as needed for discomfort.
Vaseline should be applied to the wound three to four times a day. Once the procedure has been mastered, it can be done in five to 10 minutes.
