Visual inspection of the urethra demonstrates a large, pat-ulous urethra that is shortened and may even permit visualization of the bladder neck or bladder itself. Cystoscopy is performed to confirm the absence of other pathology in the bladder such as stones, neoplasms, or diverticuli that may accompany long-term catheter drainage. Simultaneous study of the upper urinary tracts may be indicated to evaluate for hydronephrosis or ureteric obstruction. The patient should also be evaluated for manual dexterity or have an adequate caregiver to facilitate catheterization of the augmented segment. If this is not feasible, one must plan for an incontinent augmentation (ileovesicostomy) and subsequent stomal drainage or suprapubic catheter drainage. Urine cultures should be routinely assessed pre-operatively, because these patients are prone to infections. Broad-spectrum antibiotics are essential before surgery.
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