Abstract
ABSTRACTThe surgical treatment of bulbar urethral strictures is still one of the most challenging reconstructive-surgery problems. Bulbar urethral strictures are usually categorized as traumatic and non-traumatic strictures depending on the aetiology. The traumatic strictures are caused by trauma and they determine disruption of the urethra with obliteration of the urethral lumen, ending with fibrotic gaps between the urethral ends. Differently, the non-traumatic urethral strictures are mainly caused by catheterization, instrumentation, and infection, or they can also be idiopathic. They are usually associated with spongiofibrosis of the segment of the urethra that has been involved. Worldwide, two different surgical approaches are currently adopted for bulbar urethral repair: transecting techniques with end-to-end anastomosis and non-transecting techniques followed by grafting. Traumatic obliterated strictures require transection of the urethra allowing complete removal of the fibrotic tissue that involves the urethral ends. Conversely, non-traumatic, non-obliterated urethral strictures require augmentation of the urethral plate using oral mucosa grafts. Nowadays, it is still difficult to choose the correct surgical management for non-obliterated bulbar stricture repair. Indeed, different surgical techniques have been proposed (pedicled flap vs free graft, dorsal vs ventral placement of the graft, non-transecting technique using or non-using free graft, etc.) but none emerged as the best solution since all techniques have showed similar success and complication rates. Consequently, the final choice is still based on surgeon’s preferences and patient’s characteristics. Within the current manuscript, we like to present some of our tips and tricks that we developed along our prolonged surgical experience on the treatment of bulbar urethral strictures. These might be of interest for surgeons that approach this complex surgery. Moreover, our suggestions want to be useful regardless the type of chosen technique being adaptable for different scenario.
Highlights
The treatment of bulbar urethral strictures using end-to-end anastomosis was firstly described in 1914 by Hamilton Russell from Melburne, Australia
Barbagli et al described for the first time the dorsal grafting of the urethra [13] with buccal mucosa
These two different techniques were further described by Barbagli et al in 2011 and 2012 [14, 15], as well as by many different authors with similar or modified approaches [16,17,18,19,20,21,22,23]. Both have largely contributed to improve surgical outcomes in patients treated for bulbar strictures
Summary
The treatment of bulbar urethral strictures using end-to-end anastomosis was firstly described in 1914 by Hamilton Russell from Melburne, Australia. Barbagli et al described for the first time the dorsal grafting of the urethra [13] with buccal mucosa These two different techniques were further described by Barbagli et al in 2011 and 2012 [14, 15], as well as by many different authors with similar or modified approaches [16,17,18,19,20,21,22,23]. Both have largely contributed to improve surgical outcomes in patients treated for bulbar strictures. We included in this review many drawings and intraoperative photos that can be used as examples for the reader to better understand our practice
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: International braz j urol : official journal of the Brazilian Society of Urology
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
