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Gelman Visualizing Urethral Sound (CS7001)

The Gelman visualizing urethral sound (CS Surgical catalog CS7001) is a hollow, semicircular urethral sound designed by Joel Gelman (UC Irvine Center for Reconstructive Urology) that allows a flexible cystoscope to be advanced through the sound so the tip is placed against the obliterated posterior urethra under direct vision. Gelman's group uses it in place of the solid Haygrove sound when the sound tip cannot be palpated in the perineum during posterior urethroplasty for pelvic-fracture urethral injury (PFUI). The same approach has been extended to radiation-induced bulbomembranous stenosis.[1][2]

Design​

  • Hollow stainless-steel shaft with a full semicircular contour modelled on the Haygrove suprapubic-to-membranous sound.
  • Internal lumen sized to admit a flexible cystoscope (a flexible cystoscope is advanced through the hollow sound).
  • Outer diameter. Necessarily larger than a solid sound of equivalent inner working channel; this is the trade-off for adding visualization.
  • CS Surgical catalog CS7001. The manufacturer's catalog lists it as a "Gelman Visual Urethral Sound, 20 Fr I.D."[4]

Why It Exists — The Geometry Problem​

Posterior urethroplasty for PFUI / radiation stenosis requires the surgeon to identify the patent normal-caliber urethra proximal to the obliteration after the perineal dissection has transected the distal end. Historical approaches:

  1. Antegrade flexible cystoscopy through the suprapubic tract. It gives direct vision, but is technically difficult in exaggerated lithotomy with a laterally placed SPT, because the scope must traverse a sharp angle through a small-calibre tract. Some surgeons instead create a temporary vesicostomy to palpate the bladder neck, which adds time and morbidity.[2]
  2. Blind passage of a solid Haygrove sound through the SPT to the obliteration is easier mechanically, but the tip placement is by tactile feel only; the surgeon cannot confirm the sound has reached the true proximal urethral lumen versus a false passage in scar.
  3. Gelman visualizing sound combines the mechanical advantage of a semicircular sound (it negotiates the SPT-to-bladder-neck-to-membranous corridor easily) with the visual confirmation of antegrade cystoscopy (the scope inside the sound confirms tip placement at the true proximal urethra).[2]

Additional advantage: the light from the scope inside the sound transilluminates through the dissection field, helping the perineal surgeon localize the proximal urethral end during sharp dissection.[2]

Reconstructive-Urology Uses​

Posterior Anastomotic Urethroplasty for PFUI​

The dominant use. The sequence at the start of a perineal posterior urethroplasty:

  1. A midline SPT is placed at least 1 month before surgery to mature the tract (Gelman and Wisenbaugh replace a laterally placed or immature tube).[2]
  2. After perineal exposure of the distal stump, the Gelman sound is passed antegrade through the SPT into the bladder, navigated through the bladder neck, and advanced toward the obliterated segment.
  3. A flexible cystoscope is passed through the hollow sound's lumen; the operator confirms the tip is at the proximal patent lumen and not in a scarred false passage.
  4. The visualized sound tip guides sharp perineal dissection toward the true proximal lumen. If neither tip nor light can be localized in dense scar, obtain further proximal exposure before continuing; Gelman and Wisenbaugh describe scar excision and, when needed, infrapubectomy. Misdirected dissection can bypass the bladder neck and cause severe postoperative incontinence.[2]
  5. The sound is withdrawn slightly to allow excision of obliterated tissue and creation of a clean spatulated proximal end for the anastomosis.

Radiation-Induced Bulbomembranous Stenosis​

The same antegrade visualization workflow can be used for post-radiation bulbomembranous urethroplasty, where scarred, obscured planes make direct-vision tip placement attractive. The outcome series mentions the hollow Gelman or solid Haygrove sound but does not report outcomes by sound type. Among 30 patients analyzed after anastomotic urethroplasty for radiation-induced bulbomembranous stenosis, 23 met the study criteria requiring 4-month cystoscopy and postoperative patient-reported data: 22/23 (95.7%) had early cystoscopic anatomic success, 21/23 (91.3%) met the long-term success definition (stable voiding symptoms or repeat cystoscopic patency when indicated) after one late recurrence, and 21/23 (91.3%) reported satisfaction at a mean follow-up of 73.1 months.[3]

Other Reconstructive Uses​

  • Salvage urethroplasty after failed prior posterior repair, where confirming the true lumen against scar matters more. Gelman's series includes 14 patients referred after unsuccessful procedures.[2]
  • Other settings. Any antegrade-retrograde meeting-point problem, such as an obliterated membranous segment with bladder-neck disease, may benefit from the same visual confirmation. This extrapolates from the posterior-urethroplasty experience and has not been reported separately.

Evidence — Gelman 2015 Series​

In Gelman's institutional experience, 2 of 9 patients needed a temporary vesicostomy before the visualizing sound was available. After its introduction, 0 of 76 reconstructions (ages 4 to 77 years, including 6 pediatric patients and 14 referred after failed procedures) needed one, and the sound could be directed to the correct position under direct vision in every case.[2] The report is a single-center, uncontrolled, before-and-after description by the developers. It supports technical feasibility, not an outcome benefit.

Gelman Visualizing Sound vs Alternatives for Proximal-Lumen Identification​

ApproachMechanical easeVisual confirmationComment
Gelman visualizing sound + flex scopeGood (semicircular contour through SPT)Direct vision via scope through lumenDeveloper's preferred approach when the tip is not palpable[1][2]
Solid Haygrove soundGood (same contour)None (blind tactile only)Gelman's group still uses it when the tip is readily palpable in the perineum[2]
Antegrade flexible cystoscopy through SPT alonePoor (sharp angle in exaggerated lithotomy)YesOften defeated by SPT geometry
Retrograde Van Buren from urethral meatusN/ATactile only; cannot reach across obliterationNot adequate for posterior dissection alone

Technique Pearls​

  • Mature the SPT first. Gelman and Wisenbaugh place a new midline tube at least 1 month before urethroplasty so the tract is established.[2]
  • Match scope size to sound lumen. Verify on the back table before incision that the planned flexible cystoscope passes freely.
  • Expect more resistance. The hollow sound has a larger outer diameter than the solid Haygrove and may not pass readily through a tract holding a 16–18 Fr tube. Lubricate generously; Gelman and Wisenbaugh describe advancing the flexible cystoscope into the bladder first, then passing the sound over it rather than forcing the sound.[2]
  • Coordinate with the perineal surgeon. The antegrade operator advances the sound to where the perineal team needs the tip; the two work together, not sequentially.
  • Use the transillumination. Dim the OR lights briefly to localize the scope tip through the perineal scar before the next dissection move.

Limitations​

  • Outer diameter is larger than the equivalent solid sound. Passage through a tight or fresh SPT can be harder; mature the tract first.[2]
  • Requires a compatible flexible cystoscope at the same time.
  • Single-vendor instrument (CS Surgical).
  • No randomized data versus solid sound or versus antegrade-scope-alone. The evidence base is single-center observational and inference from technical-feasibility metrics.

Historical Context — Joel Gelman​

Joel Gelman, MD is Director of the Center for Reconstructive Urology at the University of California, Irvine, and a reconstructive surgeon known for posterior urethroplasty. The visualizing sound was developed at his institution: Gelman’s CV records a 1999 Western Section AUA presentation, followed by a 2012 AUA abstract and the technical discussion in his 2015 Advances in Urology review.[5][1][2]

See also: Van Buren Sound, Filiforms and Followers, Balloon Dilator, Suprapubic Catheter, Flexible Cystoscope.

References​

1. Carrillo C, Wisenbaugh ES, Gelman J. "The visualizing urethral sound in posterior urethral reconstruction." J Urol. 2012;187(4S):e3. (AUA 2012 Abstract V06-6) doi:10.1016/j.juro.2012.02.048

2. Gelman J, Wisenbaugh ES. "Posterior urethral strictures." Adv Urol. 2015;2015:628107. doi:10.1155/2015/628107

3. Barnard J, Liaw A, Gelman J. "Long-term follow-up suggests high satisfaction rates for bulbomembranous radiation-induced urethral stenoses treated with anastomotic urethroplasty." World J Urol. 2023;41(7):1905–1912. doi:10.1007/s00345-023-04429-5

4. CS Surgical, Inc. Urology catalog. Item CS7001, Gelman Visual Urethral Sound, 20 Fr I.D.

5. Gelman J. "Curriculum Vitae – Condensed Version." Center for Reconstructive Urology, pp. 7, 9. centerforreconstructiveurology.org