Abstract
Objective To explore whether it is safe to change from transecting excision and primary anastomosis (tEPA) towards nontransecting excision and primary anastomosis (ntEPA) in the treatment of short bulbar urethral strictures and to evaluate whether surgical outcomes are not negatively affected after introduction of ntEPA. Materials and Methods Two-hundred patients with short bulbar strictures were treated by tEPA (n=112) or ntEPA (n=88) between 2001 and 2017 in a single institution. Failure rate and other surgical outcomes (complications, operation time, hospital stay, catheterization time, and extravasation at first cystography) were calculated for both groups. Potentially predictive factors for failure (including ntEPA) were analyzed using Cox regression analysis. Results Median follow-up for the entire cohort was 76 months, 118 months, and 32 months for, respectively, tEPA and ntEPA (p<0.001). Nineteen (9.5%) patients suffered a failure, 13 (11.6%) with tEPA and 6 (6.8%) with ntEPA (p=0.333). High-grade (grade ≥3) complication rate was low (1%) and not higher with ntEPA. Median operation time, hospital stay, and catheterization time with tEPA and ntEPA were, respectively, 98 and 87 minutes, 3 and 2 days, and 14 and 9 days. None of these outcomes were negatively affected by the use of ntEPA. Diabetes and previous urethroplasty were significant predictors for failure (Hazard ratio resp. 0.165 and 0.355), whereas ntEPA was not. Conclusions Introduction of ntEPA did not negatively affect short-term failure rate, high-grade complication rate, operation time, catheterization time, and hospital stay in the treatment of short bulbar strictures. Diabetes and previous urethroplasty are predictive factors for failure.
Highlights
The International Consultations on Urologic Diseases (ICUD) recommends urethroplasty by excision and primary anastomosis (EPA) for short and isolated bulbar urethral strictures as it provides an excellent success rate (93.8%) with a low complication rate [1]
Case series of nontransecting EPA (ntEPA) have a promising short-term success rate of 94.5-100% [3, 5,6,7], which is in line with the composite success rate of 93.8% for the transecting EPA (tEPA) reported by the ICUD[1]
After attendance at a masterclass on urethroplasty we became familiar with the technique and being convinced of the theoretical advantages of ntEPA, we performed our first cases in November 2011
Summary
The International Consultations on Urologic Diseases (ICUD) recommends urethroplasty by excision and primary anastomosis (EPA) for short and isolated bulbar urethral strictures as it provides an excellent success rate (93.8%) with a low complication rate [1]. As EPA only requires excision of the narrowed urethra and the surrounding spongiofibrosis, a full thickness transection is usually not necessary To avoid this and to preserve the dual blood supply of the urethra, Jordan et al introduced the concept of vessel-sparing or nontransecting EPA (ntEPA) [3], later slightly modified by Andrich et al [4]. This nontransecting variant is an attempt to reduce the surgical trauma of tEPA and several centers have introduced this technique in their reconstructive repertoire[4,5,6]. To the best of our knowledge, this is the first paper to report this
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