The advantages of the ventral approach to bulbar urethroplasty

Abstract

BackgroundSeveral surgical techniques have been described for the treatment of bulbar urethral strictures, and the main goal of modern surgery is to reduce morbidity and obtain the best outcome with the fewest complications. Currently, the superiority of one surgical technique over another has not yet been clearly defined.MethodsWe analysed the historical background, advantages and disadvantages of several urethral approaches and graft placements, with the aim of focusing on the advantages of the ventral approach.ConclusionsFor short bulbar strictures (<2 cm) the traditionally advocated method is excision and end-to-end anastomosis, whilst for longer strictures, in the last decade, the patch graft urethroplasty has been used, with buccal mucosa advocated as the standard material of substitution. Our analysis showed that the approach (dorsal vs. ventral) to the bulbar urethral lumen and the location of the patch (dorsal vs. ventral) are contentious issues. Overall, surgeons tend to use techniques that are easy, quick and give excellent outcomes with few complications. The graft urethroplasty using the ventral approach fulfils these requirements.

Repair of panurethral stricture: Proximal ventral and distal dorsal onlay technique of buccal mucosal graft urethroplasty

“…Therefore, we are limiting this approach only for distal bulbar urethra, whilst for the repair of proximal bulbar stricture the ventral approach is used. The ventral approach in the proximal bulbar urethra provides direct access to the urethral lumen and a clear visualisation of the entire stricture during urethral opening [8] . Therefore, the ventral onlay grafting is more effective in the proximal bulbar urethra, where the spongiosum tissue is thick.…”