Dr. Benjamin N. Breyer

So it's technically, he's a very gifted surgeon.

It's definitely something we can all do.

I just found the ventral approach that Dimitri described to work quite well.

I mean, I think sometimes I question the use of buccal urethroplasty for short strictures when you could do a non-transsecting easily.

I think at the end of the day, though, if the person's getting a good result, that's all that matters.

Yeah.

It's a toolbox.

We all are comfortable with different things.

And as long as you're getting a good outcome, the case isn't taking too long and the patient doesn't suffer, you know, bad side effects, oral side effects, etc.

Then, you know, I can't say that I think of any one procedure being used too much or too little.

Well, I agree the buckle is still the workhorse, but I would say in terms of how my practice has changed the most, we just did a lot more anastomotic urethroplasties when I was a fellow, and now,

I don't know, 90% of those cases we do with, we approach, we circumferentially dissect around the urethra, we incise dorsally, we do a Heineken-Micklitz, non-transsecting.

I actually don't do any, if the plate is normal, and that's really the only time I'll do a non-transsecting, I don't remove any of the mucosa.

and simply just do the incision and then a heineken miclets and i've had you know what i think are strong results but you know you're really taking advantage of the geometry of the urethra when you're doing a non-transsecting urethroplasty the you know it's like an l the bulbar urethra kind of goes into the gu diaphragm becoming the membranous urethra then the prostate prostatic urethra bladder neck

you're taking advantage of that geometry at the angle of the l and you use that geometry to cover distance and and you know al mori described this with posterior urethroplasties and being able to cover you know doing an anastomotic and getting at least you know doing four centimeters if you're able to take the fascia off the sponge

Well, and then, you know, in the non-transsecting, you're getting this angle there where you can really, if you're very proximal, you can do four centimeter strictures, no problem.

However, as you get out of that proximal bulb into the mid bulb and then the distal bulb, once you get into that mid bulb doing a non-transsecting,

when you're in that long part of the L, it gets harder and harder to bunch that tissue together without being concerned that maybe core D or at least that it's not gonna be tension-free when they get an erection.

So that's when you're, in my practice, I'm really thinking about buckle.

And other considerations are sort of what the plate is like, obviously after a straddle injury,