Haygrove Sound
The Haygrove sound is a semicircular metal urethral sound (16–18 Fr) purpose-built to follow the suprapubic-tract → bladder-neck → membranous-urethra corridor in perineal posterior anastomotic urethroplasty. It is the historical workhorse for antegrade proximal-lumen identification in pelvic-fracture urethral injury (PFUI) and post-radiation bulbomembranous stenosis reconstruction, now joined (and in many centers superseded) by the hollow Gelman visualizing sound (CS7001).[1][2]
Design
- Solid stainless steel shaft, reusable, autoclavable.
- Full semicircular contour along the working length — not just a tip curve like 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 midline but often laterally placed for hostile-abdomen / prior-pelvic-surgery reasons.
- 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, with its tip-only J-curve, does not negotiate that corridor smoothly in exaggerated lithotomy — it tends to deflect at the bladder neck. The Haygrove's full semicircular profile follows the corridor anatomically, hugging the posterior bladder wall and the prostatic-membranous bend.[1]
Reconstructive-Urology Uses
Perineal Posterior Anastomotic Urethroplasty (PFUI)
The dominant use. Operative sequence:
- SPT matured ≥ 4 weeks before reconstruction.[1]
- Patient in exaggerated lithotomy; perineal exposure of the distal urethral stump.
- SPT catheter removed; the Haygrove sound passed antegrade through the tract into the bladder.
- Sound advanced through the bladder neck and the obliterated segment, palpated by the perineal surgeon as a subcutaneous impulse at the dissection plane.
- Dissection directed toward the palpated tip to find the true proximal patent lumen.
- 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
Same workflow. Long-term satisfaction data support anastomotic urethroplasty as the preferred approach for radiation-induced bulbomembranous stenoses, with the Haygrove (or Gelman visualizing sound) as the antegrade-orientation instrument of choice.[3]
Other Reconstructive Uses
- Salvage perineal urethroplasty after failed prior posterior anastomotic repair.
- Two-stage rendezvous urethroplasty when scope-meeting confirmation is unavailable and tactile palpation is the orienting cue.
Haygrove vs Gelman Visualizing Sound — When to Use Which
| Scenario | Preferred sound | Rationale |
|---|---|---|
| Routine PFUI reconstruction, mature midline SPT, no prior failed repair | Haygrove (solid) | Smaller outer diameter → easier antegrade passage; tactile palpation is reliable in undisturbed tissue planes |
| Salvage / redo posterior urethroplasty, dense scar field | Gelman visualizing (hollow + cystoscope) | Direct vision through the scope confirms true lumen vs false passage in scar[1] |
| Post-radiation bulbomembranous stenosis | Gelman preferred where available; Haygrove acceptable | Radiation field is scarred and planes obscured — direct vision is high-value |
| Lateral / hostile SPT tract | Haygrove first (smaller OD) | Hollow Gelman OD may not pass a tight or laterally angled tract |
| No availability of a compatible flexible cystoscope | Haygrove | Visualizing 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 SPT first — fresh tracts bleed and the sound tip is harder to feel through the bleeding tissue.
- Remove the SPT catheter before passage — leaving the catheter in alongside the sound creates a frictional resistance that misleads the operator about true tip position.
- Coordinate timing with the perineal team — the antegrade operator advances under the perineal team's verbal guidance; the two work together, not in series.
- Switch to a Gelman visualizing sound if more than two tactile attempts fail to localize the tip cleanly — repeated blind passes risk creating false passages.
- Lubricate generously at the SPT entry; the friction differential at the bladder neck is the most common point of tip-deflection error.
Limitations
- Blind / tactile only — no visual confirmation of tip position; the major limitation that the Gelman visualizing sound was designed to solve.[1]
- Cannot be used in patients without a mature SPT — primary perineal access is required first if no SPT exists.
- Solid construction precludes intraoperative cystoscopy through the sound.
- Single-purpose instrument — not useful for retrograde / anterior-urethral work; the Van Buren covers that role.
Historical Context
The Haygrove sound is the older instrument of the posterior-urethroplasty pair — a representative example of the purpose-built reconstructive instrumentation that emerged from the Webster / Turner-Warwick / Jordan / Morey / Gelman lineage of posterior urethral reconstruction.[1][2] The Gelman visualizing sound (CS7001) was developed at UC Irvine to address the Haygrove's blind-tactile failure mode in dense scar fields, but the solid Haygrove remains preferred in routine PFUI reconstruction where the OD advantage and reliable tactile palpation outweigh the visualization benefit.
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. Spilotros M, Mistretta FA, Sahdev V, et al. "Long-term follow-up suggests high satisfaction rates for bulbomembranous radiation-induced urethral stenoses treated with anastomotic urethroplasty." World J Urol. 2023;41(11):3013–3020. doi:10.1007/s00345-023-04429-5