Non‐transecting anastomotic bulbar urethroplasty: a preliminary report

Abstract

What ' s known on the subject? and What does the study add? Excision of a stricture and end-to-end anastomosis of the two ends is thought to be the best form of treatment for short strictures of the proximal bulbar urethra but involves transecting the main blood supply of the corpus spongiosum and the urethra. This is a preliminary report of achieving the same goal but without transecting the blood supply of the corpus spongiosum of the urethra. OBJECTIVE• To report our early experience with a novel approach to the excision and end-to-end anastomotic repair of bulbar urethral strictures. PATIENTS AND METHODS• A total of 22 patients underwent excision and end-to-end anastomosis of a proximal bulbar urethral stricture using a technique in which the corpus spongiosum is not transected, so as to maintain its blood supply intact.• The range of follow-up was 6 -21 months and for 16 patients the follow up was ≥ 1year. RESULTS• At 1 year of follow-up there was no evidence of a recurrent stricture on symptomatic assessment or urofl owmetry in the 16 patients.• On urethrography one patient has a urethral calibre 80% of normal. In the other 15 the calibre is normal or greater than normal. CONCLUSION• The non-transecting anastomotic bulbar urethroplasty technique used appears to give results that are as good as those of traditional anastomotic urethroplasty with less surgical trauma. KEYWORDSurethroplasty , urethral stricture , urethral reconstruction Study Type -Therapy (case series) Level of Evidence 4

Preliminary clinical study on non-transecting anastomotic bulbomembranous urethroplasty

“…Non-transecting anastomotic urethroplasty was first proposed by Professor Andrich [9]. The main feature of this method is that urethra end-to-end anastomosis is performed by cutting the distal and proximal ends of the urethral stricture/locked section after the dissociation of the posterior urethra.…”

Comparison of Heineke Mikulicz Stricturoplasty and End to End Anastomotic Urethroplasty Techniques for Short Bulbar Urethral Strictures

“…18,19 Fakat son zamanlarda, üretranın transeksiyonunun üretral kan dolaşımını olumsuz etkileyebileceği ve üretra iskemisine ve cinsel yan etkilere neden olacağına dair artan endişeler mevcuttur. 9,[20][21][22][23] Bu yüzden transeksiyonsuz yaklaşımlar tanımlan-mıştır. Transeksiyonsuz yaklaşımla dorsal striktüro-tominin geliştirilmesinde kilit nokta, proksimal bulbar üretranın dorsal yüzünde korpus spongiozumun bulunmamasıdır.…”

Non-transecting Bulbar Urethroplasty

“…We have independently developed the technique of nontransecting anastomotic bulbar urethroplasty with the aim of achieving the same functional outcome as EPA while avoiding the potential morbidity associated with division of the spongiosum and bulbar arteries (27). The dorsal stricturotomy approach to non-transecting urethroplasty allows the versatility of a stepwise approach to stricture management after careful intra-operative assessment of length and degree of spongiofibrosis, starting off with simple stricturoplasty for short, membrane-like strictures, progressing to excision of the spongiofibrosis and endto-end mucosal anastomosis for longer strictures, to augmentation of even longer strictures with a dorsal patch; all without transecting the urethra.…”