Dorsal versus ventral strip augmented anastomotic bulbar urethroplasty: retrospective study

Reyad, Ahmed; Mamdouh, Ahmed; Rashed, Elnisr; Fathi, Atef; Mahmoud, O. M.; Hasan, Ahmed M

doi:10.1007/s11255-018-1899-5

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…For AAU, most surgeons rely on dorsal grafting, albeit no difference in efficacy has been shown in a series comparing dorsal vs ventral positions [27]. The same holds true for ntAAU, only one recent very small series has mentioned ventral grafting as an option and performed a ventral ntAAU in three patients [28].…”

Section: Discussionmentioning

confidence: 99%

“…The six-item LUTS score, as derived from the USS PROM, significantly improved from a baseline median (IQR) score of 13 (8)(9)(10)(11)(12)(13)(14) to postoperative median (IQR) score of 3.5 (1-8) (P < 0.001). In sexually active patients, there were no differences in the median baseline vs postoperative IIEF-EF scores (median [IQR] 27 [17][18][19][20][21][22][23][24][25][26][27][28][29][30] vs 24 [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]; P = 0.4). Similarly, no differences were found in the median ICIQ-UI sum scores (median [IQR] 0 [0-8] vs 0 [0-7]; P = 0.5).…”

Section: Patient-reported Outcomesmentioning

confidence: 99%

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Mucomucosal anastomotic non‐transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures

et al. 2023

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ObjectivesTo present a surgical modification for the repair of bulbar urethral strictures containing short, highly obliterative segments and report on long‐term objective and patient‐reported outcomes.Patients and methodsWe considered patients undergoing bulbar buccal mucosal graft urethroplasty (BMGU) between July 2016 and December 2019. Eligibility criteria for mucomucosal anastomotic non‐transecting augmentation (MANTA) urethroplasty were strictures of ≥2 cm with an obliterative segment of ≤1.5 cm. The stricture is approached ventrally to avoid extensive dissection and mobilisation. Dorsally, the scar is superficially excised and the spongiosum is left intact. Dorsal mucomucosal anastomosis is complemented by ventral onlay graft. Perioperative characteristics were prospectively collected including uroflowmetry data and validated patient‐reported outcome measures on voiding, erectile, and continence function. We evaluated functional follow‐up, incorporating patient‐reported (lower urinary tract symptoms [LUTS] score) and functional success. Recurrence was defined as need of re‐treatment.ResultsOf 641 men treated with anterior BMGU, 54 (8.4%) underwent MANTA urethroplasty. Overall, 26 (48%) and 45 (83%) had a history of dilatation and urethrotomy, respectively, and 14 (26%) were redo cases. Location was bulbar in 38 (70%) and penobulbar in 16 patients (30%), and the mean (SD) graft length was 4.5 (1.4) cm. At a median (interquartile range) follow‐up of 41 (27–53) months, the functional success rate was 93%. Whereas the median LUTS score significantly improved from baseline to postoperatively (13 vs 3.5; P < 0.001), there was no change in erectile function (median International Index of Erectile Function – erectile function domain score 27 vs 24) or urinary continence (median International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form sum score 0 vs 0; all P ≥ 0.4). All patients were ‘satisfied’ (27%) or ‘very satisfied’ (73%) with the outcome of their operation.ConclusionWith excellent long‐term objective and patient‐reported outcomes, MANTA urethroplasty adds to the armamentarium for long bulbar strictures with a short obliterative segment.

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Section: Discussionmentioning

confidence: 99%

Section: Patient-reported Outcomesmentioning

confidence: 99%

Mucomucosal anastomotic non‐transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures

et al. 2023

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“…Substitution urethroplasty using buccal mucosal grafts (BMG) can be performed by several approaches including ventral onlay graft, dorsal onlay graft, or ventral urethrotomy with dorsal inlay graft. 3,4 Dorsal onlay graft was first described in 1996 by Barbagli et al 5 In 2000, Kulkarni and Kirpekar 6 used a single dorsal only graft as a one stage repair for patients with pan urethral stricture due to LS. Although a high success rate was reported using these techniques, concerns regarding compromise of the urethral blood supply were raised.…”

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confidence: 99%

Lichen sclerosis–induced long segment anterior urethral stricture: The early outcome of one-stage repair using dorsolateral onlay buccal mucosa graft

et al. 2021

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Background: Substitution urethroplasty using buccal mucosal grafts can be performed by several approaches including ventral onlay graft, dorsal onlay graft, or ventral urethrotomy with dorsal inlay graft. Our study aims to evaluate the surgical outcome of dorsolateral buccal mucosal graft for long segment anterior urethral stricture >6 cm in patients with Lichen sclerosus (LS). Methods: A retrospective study included patients who underwent repair for long segment anterior urethral stricture >6 cm due to LS between January 2013 and April 2019. All patients were followed-up at 3, 6, 9, and 12 months postoperatively and then yearly by clinical symptoms, uroflowmetry, and calculation of post-void residual urine volume. Retrograde urethrogram was requested for patients with voiding symptoms or decreased maximum flow rate. Stricture recurrence that required subsequent urethrotomy or urethroplasty was considered failure. The success rate and surgical complications were collected and analyzed. Results: Thirty patients were identified. The median age (range) was 39 (25–61) years and a median (range) stricture length was 8 (6–14) cm. Most of postoperative complications were of minor degree. The success rate at median follow-up of 15 (12–24) months was 86.5%. The median maximum flow rate increased significantly from 6 (2–11) ml/s preoperatively to 18 (range: 6–23) ml/s at the 6th month ( p value < 0.001). Conclusion: Dorsolateral buccal mucosal grafts urethroplasty for long anterior urethral stricture caused by LS has a high success rate and low risk of complications including stricture recurrence.

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“…Ayrıca, erken ve geç komplikasyonların görülme sıklığı her iki grupta benzerken, sadece işeme sonrası damlama şikayeti oranı dorsal greft grubunda daha fazla görülmüştür(13). Bizim çalışmamızda Reyad ve ark.…”

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Bulbar Üretroplastide Dorsal ve Ventral Onlay Bukkal Mukozal Greft Kullanımının Karşılaştırılması

et al. 2020

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Erkeklerde üretral darlık en sık bulbar üretrada gözlenmektedir. Bulber üretradaki 2 cm' den uzun darlıklarda, bukkal mukozal greft yerleştirilen substitüsyon üretroplastide, greftin kullanıldığı yerin cerrahi etkilerini araştırmayı amaçladık. Gereç ve Yöntemler: Kliniğimizde 2 cm'den uzun bulbar üretral darlık nedeniyle dorsal ve ventral greft onlay üretroplasti uygulanan hastaların demografik ve darlık özellikleri retrospektif olarak değerlendirildi. Dorsal ve ventral greft üretroplasti uygulanan gruplar başarı ve komplikasyon oranları açısından karşılaştırıldı. İşeme şikayetlerinin olmaması ve maksimum idrar akış hızın 15 ml/sn' in üzerinde olması başarı kriteri olarak kabul edildi. Bulgular: Dorsal onlay greft uygulanan 52 (%83,9), ventral onlay greft uygulanan 13 (%81,2) hastada üretroplasti ile başarı sağlandı. Gruplar arasında anlamlı farklılık tespit edilmedi. Demografik ve darlık özelikleri, operatif ve cerrahi sonuçlar ile komplikasyon oranları (%14,5 ve %12,5) açısından iki grup benzerlik göstermekteydi. Sonuç: Bulbar üretral darlıklarda; substitüsyon üretroplastide dorsal ve ventral onlay greft yöntemleri yüksek başarı ve güvenle tercih edilebilir.

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Dorsal versus ventral strip augmented anastomotic bulbar urethroplasty: retrospective study

Abstract: In conclusion, both dorsal strip and ventral strip techniques are feasible for long bulbar urethral strictures with comparable postoperative efficacy outcomes and high success rate.

Cited by 5 publications

References 19 publications

Mucomucosal anastomotic non‐transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures

Mucomucosal anastomotic non‐transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures

Lichen sclerosis–induced long segment anterior urethral stricture: The early outcome of one-stage repair using dorsolateral onlay buccal mucosa graft

Bulbar Üretroplastide Dorsal ve Ventral Onlay Bukkal Mukozal Greft Kullanımının Karşılaştırılması

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