Improving the technique of Ventral Onlay surgery for extended recurrent strictures of the bulbous urethra

Abstract

Background: Reconstruction of the bulbous urethra with buccal graft (BG) is considered the “gold standard“ of surgical treatment of extended urethral stricture of this localization. There is still no consensus on the best location of BG. With its ventral fixation, there are a number of natural disadvantages associated with impaired BG vascularization. Objective: To study our own results of surgical treatment of patients with extended recurrent stricture of the bulbous urethra, including our modified ventral onlay surgery technique. Material and methods: 38 people were operated on, 14 of them underwent ventral onlay surgery, 12 - ventral onlay surgery in our modification, and 12 people had a dorsal onlay surgery. The patient groups were homogeneous according to the main indicators. Results: It was found out that operations with ventral access showed a shorter duration compared to those with dorsal access, the ventral onlay operation in our modification had a significantly lower volume of blood loss than dorsal onlay. The most common complication in the long-term postoperative period was postmictional dribbling, prevailing in patients who had a standard ventral onlay surgery (35.7%). Recurrence of urethral stricture after surgery was in 7 patients (18.9%), the primary effectiveness of surgical treatment was 81.1%. Statistically significant differences between the ventral onlay/modified ventral onlay groups in the frequency of relapse were obtained. The average time to relapse was 26.5 ± 6.7 months. The second relapse occurred in 2 (5.4%) patients, thus, 94.6% of patients had no relapse (35 people). Conclusion : The study of the postoperative results of urethroplasty in these patients showed a lower number of relapses and complications in the group of modified ventral onlay surgery.