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Haygrove Sound

The Haygrove sound is a semicircular metal urethral sound (16–18 Fr) purpose-built to follow the suprapubic-tract to bladder-neck to membranous-urethra corridor in perineal posterior anastomotic urethroplasty. It is the historical instrument for antegrade proximal-lumen identification in pelvic-fracture urethral injury (PFUI) and post-radiation bulbomembranous stenosis reconstruction, now joined by the hollow Gelman visualizing sound (CS7001).[1][2]

Design​

  • Solid stainless steel shaft, reusable, autoclavable.
  • Full semicircular contour along the working length, unlike the tip curve of the Van Buren.
  • Caliber 16–18 Fr. Passes through a standard 16 Fr suprapubic tract without dilation.
  • Smooth rounded tip to minimize mucosal trauma on antegrade passage.
  • Flat handle for tactile control during blind manipulation.

Why the Contour Matters​

The operative geometry of perineal posterior urethroplasty:

  • Patient in exaggerated lithotomy.
  • Suprapubic catheter placed weeks earlier, ideally at least 16 Fr and midline, although many patients arrive with a tube far lateral to the midline, just above the symphysis or of small caliber.[1]
  • After perineal dissection of the distal urethra, the surgeon needs an antegrade marker passed through the SPT into the bladder, through the bladder neck, and down to the obliteration so the perineal team can dissect onto the true proximal lumen.[1]

The Van Buren sound is curved only at the tip and tapers to a more pointed tip, which makes it poorly suited to posterior urethroplasty, especially in exaggerated lithotomy. The Haygrove's semicircular profile is designed to follow the path from the suprapubic access to the membranous urethra.[1]

Reconstructive-Urology Uses​

Perineal Posterior Anastomotic Urethroplasty (PFUI)​

The dominant use. Operative sequence:

  1. Midline SPT. Gelman and Wisenbaugh prefer to place a new tube at least 1 month before urethroplasty when the existing tube is inadequately sized or positioned, allowing the tract to mature.[1]
  2. Patient in exaggerated lithotomy; perineal exposure of the distal urethral stump.
  3. SPT catheter removed; the Haygrove sound passed antegrade through the tract into the bladder.
  4. Sound advanced through the bladder neck to the patent proximal urethra at the obliteration; its tip is palpated by the perineal surgeon to guide dissection through the scar.[1]
  5. Dissection directed toward the palpated tip to find the true proximal patent lumen.
  6. Once the obliterative scar is excised, the sound tip is advanced through the patent proximal urethra into the perineal field, marking the spatulated end for the anastomosis.[1][2]

Post-Radiation Bulbomembranous Stenosis​

A single-center series of 23 patients undergoing anastomotic urethroplasty for radiation-induced bulbomembranous stenosis describes passage of a solid Haygrove or hollow Gelman visualizing sound through a mature suprapubic tract to identify the proximal normal-caliber urethra. Among 23 of 30 analyzed patients who completed the required 4-month cystoscopy and postoperative patient-reported assessments, the study reported 21/23 (91.3%) overall long-term success (stable voiding symptoms or wide patency on repeat cystoscopy when symptoms, elevated residual urine, or UTI prompted reassessment) and 21/23 (91.3%) satisfied or very satisfied at a mean follow-up of 73.1 months, without outcomes separated by sound type.[3]

Other Reconstructive Uses​

  • Salvage perineal urethroplasty after failed prior posterior anastomotic repair, where a palpable tip may be harder to obtain in scarred tissue.

Haygrove vs Gelman Visualizing Sound — When to Use Which​

ScenarioPreferred soundRationale
Routine PFUI reconstruction, mature midline SPT, tip palpable in the perineumHaygrove (solid)Smaller outer diameter, easier to manipulate; Gelman and Wisenbaugh continue to use the solid sound when the tip is readily palpable[1]
Tip not palpable (dense scar or malposition)Gelman visualizing (hollow + cystoscope)Direct vision through the scope directs the tip to the obliteration[1]
Post-radiation bulbomembranous stenosisEither; choose by whether the tip can be palpatedScarred planes may favor direct vision (extrapolation from the PFUI experience)
Lateral SPT tractNeither passes reliably; Gelman and Wisenbaugh prefer a new midline tube, or a temporary vesicostomyA rigid sound cannot be advanced reliably from a lateral tract to the midline bladder neck[1]
No availability of a compatible flexible cystoscopeHaygroveVisualizing sound requires simultaneous scope availability

The clinical limitation that drove the Gelman sound's invention is the Haygrove's blind-tactile failure mode in dense scar: when the tip cannot be reliably palpated through fibrosis, the surgeon cannot confirm true-lumen placement.[1]

Technique Pearls​

  • Mature the SPT first. An established tract avoids fresh-tract bleeding and the need for a temporary vesicostomy.[1]
  • Remove the SPT catheter before passage. The sound follows the tract the catheter occupied.
  • Coordinate timing with the perineal team. The antegrade operator advances under the perineal team's verbal guidance.
  • Switch to direct vision if the tip cannot be palpated cleanly after a small number of attempts; repeated blind passes risk false passages.
  • Lubricate generously at the SPT entry.

Limitations​

  • Blind or tactile only. No visual confirmation of tip position; the major limitation that the Gelman visualizing sound was designed to solve.[1]
  • Depends on an established midline SPT. Without one, the tract must be created first.
  • Solid construction precludes intraoperative cystoscopy through the sound.
  • Single-purpose instrument. Not useful for retrograde or anterior-urethral work; the Van Buren covers that role.

Historical Context​

The Haygrove sound is the older instrument of the posterior-urethroplasty pair and an example of purpose-built instrumentation for perineal posterior urethral reconstruction.[1][2] The Gelman visualizing sound (CS Surgical CS7001) was developed at UC Irvine to address the Haygrove's blind-tactile failure mode in dense scar fields, but the developers continue to use the solid Haygrove when the tip is readily palpable.[1]

See also: Gelman Visualizing Sound (CS7001), Van Buren Sound, Filiforms and Followers, Suprapubic Catheter, Perineal Bookwalter (Jordan), Flexible Cystoscope.

References​

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

2. 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

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