SIU/ICUD Consultation on Urethral Strictures: Anterior Urethra – Primary Anastomosis

Morey, Allen F.; Watkin, Nick; Shenfeld, Ofer Z.; Eltahawy, Ehab; Giúdice, Carlos

doi:10.1016/j.urology.2013.11.007

Cited by 88 publications

(95 citation statements)

References 10 publications

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“…The SIU/ICUD consultation group reported a composite 93.8% success rate with TAR for bulbar strictures 1 . This is completely in line with the 94.5% success rate of NTAR for bulbar strictures in the present series.…”

Section: Stricture Recurrencementioning

confidence: 99%

“…This technique is called the vesselsparing or non-transecting anastomotic repair (NTAR). Before recommendation of this technique, the result must be at least equivalent with the results of TAR, for which a composite success rate in terms of urethral patency of 93.8% has been reported 1 . The goal of this study is to evaluate the surgical and functional results of NTAR for short bulbar and posterior strictures.…”

Section: Introductionmentioning

confidence: 99%

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Nontransecting Anastomotic Repair in Urethral Reconstruction: Surgical and Functional Outcomes

et al. 2016

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Section: Stricture Recurrencementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nontransecting Anastomotic Repair in Urethral Reconstruction: Surgical and Functional Outcomes

et al. 2016

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“…These surveys revealed little experience with reconstructive surgery and implied unfamiliarity with the current literature and recommended treatment algorithms by expert panels [4,16] .…”

mentioning

confidence: 99%

Management of Anterior Urethral Strictures in Adults: A Survey of Contemporary Practice in Germany

Rosenbaum

Reiß²,

Borgmann³

et al. 2017

Urol Int

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Introduction: Treatment methods of anterior urethral strictures in adults have undergone considerable changes in the recent past. Our goal was to determine national practice patterns among German urologists and to compare results with the results of prior international surveys. Methods: We conducted a survey on the management of urethral strictures among German urologists. Results: Eight hundred forty-five urologists, representing about 14.6% of German urologists, answered the survey. Most common procedures were direct vision internal urethrotomy (DVIU; 87.2%), blind internal urethrotomy (57.5%), dilatation (56.3%), ventral buccal mucosa graft urethroplasty (31.6%) and excision and primary anastomosis (28.9%). In case of a 3.5-cm bulbar stricture and in the case of a 1-cm bulbar stricture after 2 failed DVIUs, a consecutive urethroplasty was significantly more often favoured compared to transurethral treatment options (44.9 vs. 21.3% and 59.4 vs. 8.3%, both p < 0.001). Conclusion: Open urethral reconstruction reveals to be a more common method in practice nowadays. Adherence to recommended treatment algorithms improved in comparison to prior surveys.

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“…However, the success rate of anastomotic urethroplasty is higher than augmentation urethroplasty. [5,9,10] There are concerns regarding erectile dysfunction and ejaculatory dysfunction after bulbar urethroplasty.…”

Section: Discussionmentioning

confidence: 99%

A novel method in decision making for the diagnosis of anterior urethral stricture: using methylene blue dye

Joshi¹,

Kaya²,

Surana³

et al. 2017

Turkish Journal of Urology

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Objective: The use of methylene blue dye (MB) to highlight anatomical structures in urology has been well-established. Urethral stricture may extend about a centimeter beyond the abnormal area seen on urethrogram. Although the current literature suggests a tension-free and end-to-end anastomosis after excision of the strictured urethral segment with spongiofibrosis and surrounding corpus spongiosum in short bulbar strictures, some centers dealing with urethroplasty prefer anastomosis for short bulbar strictures while others prefer augmentation. With this study, use of MB for delineating stricture line and assessing spongiofibrosis in the diagnosis of urethral stricture was evaluated. Material and methods:Five cc MB including 10 mg/mL is diluted with 10 cc saline. In the first scenario, MB is gently injected into urethra via the meatus before the urethroplasty procedure. Meanwhile, the extent of urethral segment stained by MB is noted. In the second scenario (MB spongiosography) in short bulbar stricture, insulin needles are inserted in spongiosa of the stricture site distally and proximally. MB is gently injected with distal needle. The two remaining needles are then observed. Presence of MB efflux in proximal needle implies deficiency of significant spongiofibrosis, so buccal augmentation is performed. Absence of efflux of MB implies significant spongiofibrosis and anastomotik site excised.Results: Four hundred and ninety-two consecutive cases prospectively evaluated between 2010 and 2014. Precise staining of stricture was successfully observed in 464 (94%) patients. Grossly normal appearing urothelium remained pink. Histopathology confirmed that the stained urethra had a stricture. Of the 22 short bulbar idiopathic strictures, in 18 (82%) MB was seen across the stricture and urethral transection was avoided. Anastomosis was performed in 4 (18%) cases where no MB went across the primary excision. There were no known allergic complications.Conclusion: MB aids in delineating the urethral lumen and exact site of stricture that needs augmentation. MB Spongiography in short bulbar strictures could be used as a beneficial guide in relation to the type of urethral repair to be performed in terms of augmentation versus excision and anastomosis.

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SIU/ICUD Consultation on Urethral Strictures: Anterior Urethra – Primary Anastomosis

Cited by 88 publications

References 10 publications

Nontransecting Anastomotic Repair in Urethral Reconstruction: Surgical and Functional Outcomes

Nontransecting Anastomotic Repair in Urethral Reconstruction: Surgical and Functional Outcomes

Management of Anterior Urethral Strictures in Adults: A Survey of Contemporary Practice in Germany

A novel method in decision making for the diagnosis of anterior urethral stricture: using methylene blue dye

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