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Rongeur

A rongeur (from the French ronger, "to gnaw") is a bone-biting forceps with a hinged handle and sharp cupped jaws that remove bone in small controlled bites. Jaw size, curvature and mechanical linkage differ between models. Leksell-type instruments commonly use a double-action mechanism, which multiplies mechanical advantage for harder bone. The exact device's intended tissue and dimensions should guide selection.[1][2]

Instrument Families​

  • Leksell. Large curved jaws, a neurosurgical and spinal instrument that is commonly used for pubic bone debridement in urology.
  • Stille. Straight, heavy-duty jaws.
  • Kerrison. Thin upward-biting design with a thin footplate that fits narrow corridors, used mainly in spinal surgery and rarely at the pubis.
  • Lempert. Smaller jaws for finer bone work.

Fine pituitary rongeurs have a different intended use and are not automatic substitutes for cortical-bone cutting.

Use in Reconstructive Urology​

  • Partial pubectomy for urethropubic fistula with osteomyelitis.
  • Pubic symphysis debridement in urethropubic and pubovesical fistula, removing infected or nonviable bone.
  • Inferior wedge pubectomy during PFUI reconstruction. A wedge of the inferior pubic arch is excised with rongeurs, alone or together with an osteotome or gouge, to shorten the urethral route and expose the prostatic apex.[4][5] Rongeurs can also trim bony fragments encroaching on the urethral field.
  • Pelvic ring exposure during complex posterior urethroplasty, which is uncommon and is often deferred to orthopedics.

In urethropubic fistula with osteomyelitis, removal of infected or nonviable bone is part of a broader source-control and reconstruction strategy. Bone is debrided back to viable, bleeding cancellous bone. Bleeding is an assessment cue that is affected by tissue condition and prior treatment, so it is not the only definition of the resection boundary, and it does not mean all cortex must be removed.

Handling Principles​

  • Take small bites. Each squeeze removes a discrete chunk, and oversized bites fracture bone or damage the instrument. Obtain a visible purchase suited to the jaw capacity.
  • Protect adjacent soft tissue and keep it out of the jaws. Reassess a deep or poorly seen bite before closing.
  • Irrigate and clear bone chips frequently to maintain visibility. Do not use the jaws as a lever against unexposed structures.
  • Strip periosteum with a periosteal elevator only where the planned exposure requires it.
  • Inspect the jaws and linkage before and after use, and follow model-specific reprocessing instructions.

In a retrospective series of 88 men undergoing delayed anastomotic urethroplasty with pubectomy for PFUI, median blood loss was 453 mL with a rongeur and/or gouge (n = 15) versus 149 mL with an air drill (n = 73); median operative times were 228 and 256 minutes, respectively (P = 0.31).[3] Selection depends on the task, access, bone quality and operator experience.

See also: Air Drill, Osteotome and Mallet, Periosteal Elevator, PFUI.

References​

1. Sklar. Leksell Rongeur, 40-4092. Product description/specifications; accessed September 12, 2026. Manufacturer information.

2. FDA/NLM AccessGUDID. Leksell rongeur, DI 00190660151799. Device description and nomenclature; accessed September 12, 2026. Device record.

3. Horiguchi A, Ojima K, Shinchi M, et al. "Usefulness of a high-speed surgical air drill in pubectomy during delayed anastomotic urethroplasty for pelvic fracture urethral injury." Int J Urol. 2020;27(11):1002-1007. doi:10.1111/iju.14344

4. Gomez RG, Scarberry K. "Anatomy and techniques in posterior urethroplasty." Transl Androl Urol. 2018;7(4):567-579. doi:10.21037/tau.2018.03.05

5. Webster GD, Peterson AC. "Simple perineal and elaborated perineal posterior urethroplasty." Arab J Urol. 2015;13(1):17-23. doi:10.1016/j.aju.2015.01.002