Step 1 Inspection and demarcation of the white line F. Gomez Sancha

A circumferential incision is carried out to mark the limit between the apex of the adenoma and the external sphincter, respecting the veru montanum. The crista urethralis is not cut. This “white line” will serve as a landmark for sphincter preservation throughout the procedure.

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The procedure starts at the apex marking the “white line” demarcating the limit of the external sphincter (Picture 1). 

Figure: procedure-steps