Longitudinal incisions are made at least at 3 and 9 0’clock positions to open the stricture.

In VUAS cases, the incision is cut down to approximately 30 French.

In BNS cases, the incision continues until healthy perivesical fat is encountered.

Hemostasis is managed with electrocautery.

The JNW URTRAC® Instrument Guide is inserted into the urethra and advanced to the surgical defect or stricture location. Through this instrument guide, a flexible digital ureteroscope and the RD180®/RD® Device are introduced via separate working channels.

Using the RD180®/RD® Device, 2-0 Monoglide® Suture is used to place a single interrupted stitch in a transverse fashion. The first bite is taken at the midpoint of the bladder-side mucosa.

After rearming the RD180®/RD® Device, a corresponding bite is made in the urethral-side mucosa.

The suture tails are externally threaded through a Ti-KNOT® Device. The Ti-KNOT® Device is then advanced internally under endoscopic visualization to cinch and secure the mucosa with a titanium fastener, bringing the edges together transversely in a Heineke-Mikulicz fashion.

Duplicate steps 3,4, and 5 at the 9 o’clock position.

This process reestablishes continuity between the bladder and urethral mucosa, increasing the caliber of the lumen to allow urine to pass more easily.