The augmented anastomotic urethroplasty

Abstract

Primary anastomotic urethroplasty with complete stricture excision provides for the most successful outcome in bulbar urethral reconstruction. However, there are times when, following stricture excision and urethral spatulation, too much tension would be present for a primary anastomosis. The augmented anastomotic urethroplasty is a combination repair that incorporates the principles of excision and substitution urethroplasty. It is intended for bulbar strictures deemed too long for straightforward primary anastomosis, particularly those with a dense area of scarring and adjacent wider caliber stricture. With this technique, up to 2 or 3 cm of strictured urethra may be excised, followed by reapproximation of either the dorsal or ventral walls. The opposite urethral wall is then closed with an onlay graft. In this chapter, we discuss our graded approach to the management of bulbar strictures and our rationale for utilizing the augmented anastomotic repair and outline our surgical technique.