Bulbar Urethroplasty Research Articles

Bulbar urethroplasty techniques and stricture recurrence: differences between end-to-end urethroplasty versus the use of graft.

Urethral stricture (US) affects most commonly the anterior portion of the urethra, concretely the bulbar, with a significant incidence in men. Open urethroplasty is the gold standard treatment. However, stricture recurrence (SR) remains a current subject of concern. The aim of the present review is to provide an updated literature summary on surgical urethroplasty techniques for bulbar US and prognostic factors for SR, comparing the different approaches. For short strictures, excision and primary anastomosis (EPA) is the preferred option, with success rates exceeding 90%. Substitution techniques are usually required for longer strictures (>2-3cm). Buccal mucosa graft (BMG) remains the first choice as it complies with ideal features, with no significant differences regarding the site of graft implantation. Stricture length, time since urethroplasty and number of previous urethral interventions are risk factors for failure. Also, surgeon's experience affects technique selection and future outcomes. There seems to be consensus on a higher SR rate following substitution techniques compared to EPA, which appears to be influenced by the stricture length, usually longer in the former group. Furthermore, there is a trend in favor of endoscopic management of SR, except for long and complex recurrences where grafts should be used. In conclusion, multiple urethroplasty techniques are available and selection must be carefully individualized, focusing on stricture characteristics, patient's history, and surgeon's experience. Well-designed studies with clear definitions and follow-up protocols are still necessary to develop standardized guidelines on the management of bulbar US.

Total bulbospongiosum muscle sparing for bulbar urethroplasty: beyond the one‐sided dissection

Total bulbospongiosum muscle sparing for bulbar urethroplasty: beyond the one‐sided dissection

Current Trends in the Use of Buccal Grafts During Urethroplasty Among Society of Genitourinary Reconstructive Surgeons

ObjectivesTo analyze current standards in urethroplasty by urologists employing buccal mucosal grafts (BMG) for treating urethral stricture disease (USD). MethodsAn IRB-approved online survey was distributed to members of the Society of Genitourinary Reconstructive Surgeons (GURS) between July and October 2022 to assess BMG utilization in urethroplasty. Questions covered surgeon experience, graft harvest site, graft length, surgical technique, and perceived success rates. ResultsOf 350 invited GURS members, 134 responded (38%). 69% were GURS fellowship-trained, performing 10-30 urethroplasties annually. 95% harvested their own grafts, with 99% preferring buccal mucosa as the primary site. Buccal mucosa was favored over fasciocutaneous flap for penile urethroplasty, regardless of circumcision status (95% with, 84% without). For bulbar urethroplasty with BMG, dorsal graft placement was favored (66%) over ventral (34%). Most surgeons (90%) preferred multiple BMGs over combined graft/flap for panurethral strictures. When harvesting long grafts, 56% preferred using both cheeks. Anastomotic urethroplasty was preferred over buccal graft urethroplasty for short bulbomembranous stenosis post-radiotherapy (63% vs. 37%). Surgeons reported a success rate of 80-90% (53%). ConclusionsThe expanded scope of reconstructive urology has led to increased use of BMG in diverse urethral reconstructions. Buccal grafts are now preferred for penile, bulbar, and panurethral strictures, demonstrating high perceived success rates in the reconstructive community.

Small intestinal submucosa graft bulbar urethroplasty is a viable technique: results compared to buccal mucosa graft urethroplasty after propensity score matching.

Small intestinal submucosa (SIS) graft urethroplasty has been employed to decrease buccal mucosa morbidity and facilitate the procedure. The first published series had a short follow-up, inhomogeneous patient selection, and a lack of a control group. Our purpose is to report treatment outcomes at 13years in a propensity score-matched cohort comparing bulbar urethroplasty with SIS (SISU) or buccal mucosa (BMU). From our institutional database of 1132 bulbar urethroplasties, we used propensity score matching with the nearest-neighbor method without replacement to generate a study sample of 25 BMU and 25 SISU. Failure was defined as any treatment after urethroplasty. Survival analyses were used to analyze treatment failure occurrence with data censored at 156mo. Matching resulted in a complete correction of bias between the two samples except for the follow-up duration, which was slightly longer in the SIS group. The cumulative treatment success probability of BMU and SISU at 156mo was 83.4% and 68%, respectively. At multivariable Cox regression, SIS graft, previous urethrotomy, stricture length, and lower postoperative Qmax (within 2mo after catheter removal) were predictors of failure. Stricture length had a more remarkable effect in SISU, with estimated survival probabilities from the Cox model lower than 80% in strictures > = 3cm. SIS has poorer outcomes compared to BM but may still be useful when BM grafting is not possible. The best candidates for SISU, with similar success to BMU, are patients with strictures shorter than 3cm, preferably without a history of DVIU.

(205) Functional Outcomes in Non-Transecting Excision-Anastomosis Urethroplasty for Lengthy (≥2cm) Urethral Strictures

Abstract Introduction Spongiosal sparing non-transecting anastomotic bulbar urethroplasty has rapidly become the preferred technique for many reconstructive urologists due to reported improvement in postoperative erectile function outcomes. For strictures <2cm, non-transecting techniques without the use of graft augmentation are typically deployed. However, for lengthy bulbar strictures (≥2cm), many advocate for oral mucosa substitution urethroplasty due to the theoretical concern of penile shortening, tethering, or other erectile function related side effects. Although effective, substitution bulbar urethroplasty is associated with additional graft harvest morbidity and may have lower success rates relative to non-substitution non-transecting techniques. Objective We describe outcomes of an extended non-transecting excision-anastomosis urethroplasty for lengthy urethral strictures without the use of graft augmentation. Methods A tertiary center’s urethroplasty database was queried for patients that underwent non-transecting bulbar urethroplasty from 2017-2023. Patients with penile urethral strictures or concurrent urethroplasty procedures were excluded. Stretch penile length (SPL) was assessed by applying gentle traction on the penis and measuring from the base of the penis to the tip of the glans. SPL was assessed perioperatively and at 3-6 month follow-up. Urethral stricture recurrence was defined as need for repeat urethral intervention. Urethral stricture length was determined by intra-operative measurement. Accordingly, patients were then stratified based on stricture length (<2 cm vs ≥2 cm) and tested for association between categorical outcomes (worsening erectile function and reconstructive success) and continuous outcomes (change in SPL) using Fischer’s exact test and Mann Whitney U test. Results A final cohort of 90 patients were identified, with a median urethral stricture length of 1.5 cm (range 0.5-6cm). In addition to dorsal urethrotomy (median 3cm), ventral mucosectomy was performed in 29 (32%) patients (median 2cm). Early postoperative complications occurred in 13 (15%) including UTI (N=4), contrast extravasation at VCUG (N=3), and epididymo-orchitis (N=3). At a median follow up of 13 months (IQR 4-18), a total of 5.5% (5/90) developed stricture recurrence. The overall median change in SPL was 0% (IQR 0-6.7%). De novo ED occurred in 7% (5/67). When stratified by stricture length ≥2cm (N=41) and <2cm (N=49) median length of urethrotomy was 3 cm (2.6-4.0) vs 2 cm (2.0-3.0; p <0.001), respectively. Those with strictures ≥2 cm had greater decreases in relative SPL (median 3.5% vs. 0%, p = 0.003) and higher absolute PVR (median 71 ml vs. 34 ml, p =0.03) at 3 months after surgery. There were no significant differences in relative improvement of Qmax or PVR, stricture recurrence (8% vs 4%), worsening erectile function (10% vs 6%), or complication rates (15% vs 14%) between groups (p-value> 0.05 for all comparisons). Conclusions Spongiosal sparing non-transecting urethroplasty is an effective surgical option for patients with lengthy urethral strictures. It offers comparable relative improvement in functional (Qmax, PVR) and erectile function outcomes, while having a modest impact on SPL all while avoiding the morbidity of graft harvesting. Disclosure No.

Low risk of erectile dysfunction after nontransecting bulbar urethroplasty for urethral stricture: a systematic review and meta-analysis.

Sexual function after urethroplasty may be a concern for patients, but there are still some controversies regarding the consequences of nontransecting bulbar urethroplasty (ntBU) in terms of erectile dysfunction (ED). This meta-analysis aimed to compare the efficacy and safety of ntBU with that of transecting bulbar urethroplasty (tBU). The PubMed, Web of Science, Cochrane, and Embase databases were searched and reviewed up to October 31, 2022. Quality evaluation was performed using the Newcastle-Ottawa scale system and Cochrane tools for the nonrandomized and randomized studies, respectively. Baseline characteristics, preoperative information, and postoperative outcomes were collected. Outcomes included success rate, ED, overall complication, and maximum urinary flow. Thirteen studies comprising 1683 patients met the inclusion criteria, with 596 and 1087 patients undergoing ntBU and tBU, respectively. The results revealed that compared with the tBU group, the patients who underwent ntBU had a significantly lower incidence of ED, while there were no significant differences in the other perioperative outcomes. In subgroup analysis, the nontransecting anastomotic urethroplasty group had a lower incidence of ED than excision and primary anastomosis, and other perioperative outcomes were similar between the 2 groups. The results of the study may help clinicians choose procedures that protect sexual function in the treatment of urethral stricture. The strength of this study is that it is, to our knowledge, the first meta-analysis to evaluate the efficacy and safety of ntBU. A limitation is that most of the included studies were retrospective cohort studies. ntBU preserves the high efficacy of its transecting counterpart while reducing postoperative ED.

Erectile function after different techniques of bulbar urethroplasty: does urethral transection make a difference?

PurposeWe aimed to compare the impact of urethral transection after different techniques of bulbar urethroplasty on erectile function outcome.Materials and methodsWe retrospectively reviewed the records for 245 patients who underwent different urethroplasty techniques for bulbar urethral stricture between February 2013 and January 2021. The comparison between the transecting and non-transecting cohorts included patients’ demographics, clinicopathological features of the urethral stricture, post-urethroplasty erectile function, and success of urethroplasty. Outcomes were erectile function status verified by IIEF5-15 score at preoperative, three months, and 12 months post-surgery. We defined Post-urethroplasty ED as a decrease of 5 points or more.ResultsThe urethroplasty success rate of the entire cohort was 86.9% after a mean follow-up of 45.59 ± 21 months. Out of 245 patients, 18 (7.3%) experienced 90-day complications. Transecting bulbar urethroplasty techniques were performed in 74 patients (30.2%), while non-transecting techniques were performed in 171 patients (69.8%). there were no differences between the cohorts regarding urethroplasty success (87.8% Vs. 86.5%, Mantel-Cox test p = 0.93) or postoperative complications (8.1% Vs. 7%, p = 0.73). Transient ED was evident in the transecting cohort as reported in 8.1% compared to 2.9% for the non-transecting (p = 0.07).Still, but de novo permanent ED was comparable (4.1% Vs. 2.9%, p = 0.65), for transecting and non-transecting, respectively.ConclusionsUnfortunately, some patients who undergo transecting techniques of bulbar urethroplasty experience transient erectile dysfunction that can improve within the first post- urethroplasty year; however, de novo permanent erectile dysfunction is uncommon after different techniques of bulbar urethroplasty and is not predisposed by urethral transection.

Comment on: "Long-term follow-up of two-sided dorsal plus ventral oral graft bulbar urethroplasty: single-center experience on 216 patients".

Comment on: "Long-term follow-up of two-sided dorsal plus ventral oral graft bulbar urethroplasty: single-center experience on 216 patients".

Patient-Reported Outcome Measures Using Modified Urethral Stricture Surgery

Purpose: To evaluate the patient-reported outcomes of primary direct visual internal urethrotomy (DVIU) and nontransecting bulbar urethroplasty techniques (NTBU) for the short segment (<2 cm) nontraumatic bulbar urethral stricture using the modified urethral stricture surgery patient-reported outcome measures (USS PROMs). Materials and Methods: The USS PROM questionnaire used to evaluate lower urinary tract symptom (LUTS) was modified by adding a six-item International Index of Erectile Function and a four-item version of MSHQ-EjD to evaluate erectile and ejaculatory domains. All cases of short nontraumatic bulbar urethral stricture who underwent primary DVIU and NTBU who consented were asked to fill the modified PROM at initial evaluation, at 6 months, and at 1 year. Results: The LUTS score for NTBU at 12 months is significantly better (1.93 ± 2.13 vs. 8.76 ± 5.92, P = 0.000). The Peeling score of the NTBU is significantly better at 12 months (1.41 ± 0.68 vs. 2.67 ± 0.73, P = 0.000). The erectile function score at 12 months for NTBU is better than DVIU (24.37 ± 3.2 vs. 21.143 ± 2.86, P = 0.001). The Ejaculatory function score at 6 months and 12 months is significantly better for the NTBU. Receiver operating characteristic (ROC) AND Odd's Ratio analysis for analyzing patient satisfaction showed erectile function (area under ROC [AUROC] - 0.889, P < 0.001), ejaculatory function (AUROC - 0.957, P < 0.001) at 1 year and maximum flow rate of urine on uroflometry (Qmax) (AUROC - 0.928, P < 0.001) at 6 months and (AUROC - 1.000, P < 0.001) at 1 year. The overall satisfaction rates in patients undergoing NTBU is 96.5%. Conclusion: NTBU shows superior outcomes in almost all domains of USS-PROM with better overall satisfaction rates. Improvement of sexual function domain, followed by the LUTS domain was the best predictor of overall patient satisfaction and improvement in the quality of life at 1 year.

Erectile and voiding function outcomes after buccal mucosa graft urethroplasty for long-segment bulbar urethral stricture: ventral versus dorsal onlay technique.

To compare the impact of dorsal versus ventral onlay buccal mucosa graft bulbar urethroplasty on postoperative erectile function status. We retrospectively reviewed the records for 232 patients who underwent dorsal and ventral onlay buccal mucosa graft bulbar urethroplasty from March 2012 to April 2021. Outcomes were urinary and erectile function status as assessed by IIEF5-15 score at preoperative, three months, and 12months post-urethroplasty. We compared the dorsal and ventral only techniques at the different follow-up visits using difference-in-differences analysis. 165 patients met our inclusion criteria; the overall success rate was 87.9% after a mean follow-up of 52.3 ± 18.5months. Of the patients, 17.6% experienced a 90-day complication. When comparing dorsal and ventral only techniques, there were no significant differences in terms of success rate (88.3% vs. 87.1%, Mantel-Cox test p = 0.68) or postoperative complications (15.5% Vs. 19.4%, p = 0.3). Likewise, there was no significant difference between both techniques regarding postoperative erectile function as assessed by IIEF5-15 score after three months (26.28 ± 2.53 Vs. 26.37 ± 2.41; p = 0.836) and twelve months (26.88 ± 2.45 Vs. 26.48 ± 1.98; p = 0.532). We detected a post-urethroplasty transient ED in (3.9% vs. 1.6%; p = 0.41), and permanent ED in (1.9% vs. 3.2%; p = 0.6) for dorsal and ventral onlay, respectively. Onlay Buccal mucosa graft urethroplasty is a highly effective surgery in treating long-segment bulbar urethral stricture. The dorsal and ventral only techniques were comparable regarding urinary and erectile function outcomes. Additionally, both techniques have no significant negative impact on post-urethroplasty erectile function status.

Comparison of Single versus Double BMG Urethroplasty in the Treatment of Bulbar Urethral Stricture

Background: Bulbar urethral strictures require comprehensive and careful urological management. Augmentation urethroplasty is the preferred treatment method and buccal mucosa has gained widespread popularity as the graft of choice for bulbar urethroplasty. Objective: To compare the outcomes of single versus double BMG urethroplasty in the treatment of bulbar urethral stricture. Methods: This prospective observational study was conducted in the Department of Urology, National Institute of Kidney Diseases and Urology, Sher-e-Bangla Nagar, Dhaka from July 2018 to December 2019 over a period of one and half years. In this study, 22 patients had single BMG urethroplasty and 38 patients had double BMG urethroplasty. Qmax, dilation requirement, recurrent stricture and postoperative complications were recorded and compared. SPSS 12 was used for analysis. Categorical data were compared with Chi-square test and numerical data were compared with unpaired t test. Results: Maximum patients were more than 40 years old in both groups. Mean age was 40.77 ± 8.52 years & 38.97 ± 10.07 years in single and double BMG group respectively (p>0.05). Most of the patients were either overweight or obese in both groups (p>0.05). In most of the cases aetiology of structure was unknown in both groups. Length of graft was 4.59 ± 0.65 cm and 4.43 ± 0.51 cm in single and double BMG group respectively. Peroperative Qmax was 8.00 ± 1.54 ml/sec and 7.61 ± 1.73 ml/sec in single and double BMG group respectively. Postoperative Qmax after 1 month and after 3 months was significantly higher in double BMG group than single BMG group (23.87 ± 1.79 ml/sec vs 21.73 ± 2.37 ml/sec and 20.71 ± 3.25 ml/sec vs 14.95 ± 1.29 ml/sec). Percent increment of Qmax after 3 months comparing pre-operative was significantly higher in double BMG urethroplasty group than that of single BMG urethroplasty group. Wound infection was higher in single BMG group than that of double BMG group but difference was not statistically significant (27.3% vs 13.2%; p=0.310). Recurrent of stricture was significantly higher in single BMG urethroplasty group than that of double BMG urethroplasty group (45.5% vs 21.1%; p=0.04 Conclusion Double BMG urethroplasty is better than single BMG urethroplasty in the treatment of bulbar urethral strictures. Bangladesh J. Urol. 2021; 24(1): 82-86

Transcroporal Artificial Urinary Sphincter Placement With Closure of Corporal Bodies—A Long-Term Analysis of Functional Outcomes

ObjectivesAn artificial urinary sphincter (AUS) is the gold standard for postoperative stress urinary incontinence (SUI). The transcorporal AUS (TC) placement constitutes the main salvage option in high-risk patients suffering from SUI with fragile urethras. The literature analyzing long-term outcomes with respect to explantation rates, continence, and erectile function is scarce.Methods and PatientsRetrospective data collection was performed in 2011. TC was applied according to a standardized protocol. TC was implanted after bulbar urethroplasty or double-cuff (DC) explantation. After TC placement, the tunica albuginea was closed in order to minimize the risk of postoperative bleedings and erectile dysfunction. Activation was performed 6 weeks postoperatively. Further follow-up (FU) was scheduled 6/24 months postoperatively and every 2 years thereafter. Primary/secondary endpoints were explantation/objective, subjective, and social continence rates. Objective or social continence was defined as the use of 0 pads/day or <2 pads/day, respectively. Thereupon, postoperative bleedings and erectile function were analyzed.ResultsA total of 39 high-risk patients were available for analysis. The median age was 72 years. In total, 84.6%, 10.3%, and 2.6% had a history of radical prostatectomy, TURP, and radical cystectomy, respectively. In total, 61.5% had a history of radiation therapy of the prostate, 41% had a history of urethral surgery, and 95% had a history of double cuff explantation. The median FU was 27 months. Objective, subjective, and social continence were 54.5%, 69.7%, and 78.8%, respectively. The median pad usage was 1 pad/day [1–2.5]. Only one patient suffered from a postoperative hematoma. In total, 15.4% of the patients were able to have an erection preoperatively, compared to 7.7% after TC placement. The estimated mean explantation-free survival of the TC was 83 months in the Kaplan–Meier analysis.ConclusionsTC AUS implantation constitutes a viable salvage approach in high-risk SUI patients with a mean device survival of almost 7 years and high social continence rates of almost 80%. An intraoperative closure of the tunica albuginea after TC placement allows for very low rates of postoperative hematoma and supports postoperative erectile rigidity.

PD31-11 PATIENT, STRICTURE, AND URETHROPLASTY PREDICTORS OF ERECTILE DYSFUNCTION AFTER URETHROPLASTY FOR BULBAR URETHRAL STRICTURES

You have accessJournal of UrologyCME1 May 2022PD31-11 PATIENT, STRICTURE, AND URETHROPLASTY PREDICTORS OF ERECTILE DYSFUNCTION AFTER URETHROPLASTY FOR BULBAR URETHRAL STRICTURES Justin Drobish, Shawn Grove, Nejd Alsikafi, Joshua Broghammer, Jill Buckley, Sean Elliott, Jeremy Myers, Andrew Peterson, Keith Rourke, Thomas Smith, Alex Vanni, Lee Zhao, and Bradley Erickson Justin DrobishJustin Drobish More articles by this author , Shawn GroveShawn Grove More articles by this author , Nejd AlsikafiNejd Alsikafi More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Jill BuckleyJill Buckley More articles by this author , Sean ElliottSean Elliott More articles by this author , Jeremy MyersJeremy Myers More articles by this author , Andrew PetersonAndrew Peterson More articles by this author , Keith RourkeKeith Rourke More articles by this author , Thomas SmithThomas Smith More articles by this author , Alex VanniAlex Vanni More articles by this author , Lee ZhaoLee Zhao More articles by this author , and Bradley EricksonBradley Erickson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002582.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bulbar urethroplasty (BU) for urethral stricture disease can significantly improve urinary quality of life (QOL). However, prior studies have shown that while erectile dysfunction (ED) is rare, its presence after BU negatively affects QOL and satisfaction regardless of stricture outcome. Herein we analyze patient, stricture and urethroplasty variables and their association with post-BU ED. METHODS: The Trauma and Urologic Reconstruction Network of Surgeons (TURNS) prospective database was used to create a cohort of bulbar (S1a/S1b; no posterior or penile urethral extension) urethral strictures that underwent single-stage BU from 2010 to 2018 with minimum 3-year clinical follow-up (database + retrospective chart review) not associated with hypospadias. Patient, stricture, and repair variables were analyzed for their association with ED, which was determined with retrospective chart review of both urologic and non-urologic clinical visits in the 12 months after BU, looking for patient complaints of ED and/or new prescriptions for ED medications, with uni- and multivariable models. Patient-reported recovery of erectile function was also assessed with chart review. RESULTS: At a median follow-up time was 65.1 months, 108 (7.3%) of 1480 study subjects were noted to have clinically significant post-BU ED. Uni- and multivariate predictors of post-BU ED are shown in the Table. On multivariate analysis, a history of pelvic radiation and BU involving urethral excision/transection significantly increased the odds of ED. Recovery of function was confirmed 56 (51.9%) at a median follow-up of 19 mo. and was not affected by repair type. CONCLUSIONS: Clinically significant changes in erectile function occurs in at least 7% of BU cases, with urethral excision/transection and radiation history significantly increasing the odds. Notably, traditional patient factors associated with ED, including as age, BMI and smoking history, did not affect the development of de novo post-BU ED. Most, but not all, patients appear to recover with time. Source of Funding: NIDDK 1R21DK115945-01 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e545 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Drobish More articles by this author Shawn Grove More articles by this author Nejd Alsikafi More articles by this author Joshua Broghammer More articles by this author Jill Buckley More articles by this author Sean Elliott More articles by this author Jeremy Myers More articles by this author Andrew Peterson More articles by this author Keith Rourke More articles by this author Thomas Smith More articles by this author Alex Vanni More articles by this author Lee Zhao More articles by this author Bradley Erickson More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP22-18 REVISION URETHROPLASTY AFTER FAILED EXCISION AND PRIMARY ANASTOMOSIS AND TISSUE TRANSFER REPAIR FOR BULBAR URETHRAL STRICTURES: OUTCOME ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP22-18 REVISION URETHROPLASTY AFTER FAILED EXCISION AND PRIMARY ANASTOMOSIS AND TISSUE TRANSFER REPAIR FOR BULBAR URETHRAL STRICTURES: OUTCOME ANALYSIS David Barham, Aron Liaw, and Joel Gelman David BarhamDavid Barham More articles by this author , Aron LiawAron Liaw More articles by this author , and Joel GelmanJoel Gelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002561.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The published short and long-term success rates for anastomotic and dorsal buccal onlay urethroplasty for the treatment of bulbar strictures are as high as 95-99% at centers of excellence. As urethroplasty is being performed with increased frequency, more patients are presenting for re-do urethroplasty with highly complex and/or long strictures, especially after surgery performed by urologists without fellowship training and/or specialization in Male Reconstructive Urology. We report our 20-year experience and long-term outcomes with revision surgery when patients present to our institution after failed excision and primary anastomosis (EPA) or tissue transfer bulbar urethroplasty. METHODS: We reviewed our IRB approved, prospectively maintained database for patients who had repeat urethroplasty for bulbar or distal membranous stricture. Success was defined as a urethra >16Fr on followup cystoscopy and absence of obstructive voiding symptoms. RESULTS: 43 patients were identified, with a mean followup of 66 months (4-210). 21/43 (48%) had previously undergone EPA. Of these, 13/21 (62%) had a mean stricture length 6.8 cm, and underwent buccal graft urethroplasty as a revision. Conversely, 18/43 (42%) had previously undergone a graft urethroplasty, and of those, 9/18 (50%) underwent EPA as a salvage operation. The remaining 4 patients had prior flap surgery (2/43), or multiple different prior urethroplasties (2/43). 6/43 (14%) had documented recurrence of stricture, 3/6 of which were in the group that had previous graft urethroplasty and had EPA as a revision. CONCLUSIONS: Most patients with failed anastomotic urethroplasty had long stricture length and required tissue transfer for revision, indicating increased complexity after failure. Patients with failed graft urethroplasty did well when their revision was done with tissue transfer, but there was a higher failure rate in those who underwent anastomotic repair after a failed graft. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e378 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Barham More articles by this author Aron Liaw More articles by this author Joel Gelman More articles by this author Expand All Advertisement PDF DownloadLoading ...

Mucosal-sparing augmented non-transected anastomotic (MsANTA) urethroplasty: a step forward in ANTA urethroplasty.

The surgical advancement of urethral reconstruction is a rapidly moving field. In the last decade, the technique for bulbar urethroplasty has evolved towards less invasive approaches with minimal transection and more tissue sparing in order to increase the patency rate. In this study, we provide a step forward in the augmented non‐transected anastomotic (ANTA) urethroplasty proposed in 2012, with a true mucosa‐sparing modification of the technique. In detail, the bulbar urethral lumen is approached with either a ventral or dorsal urethrotomy. Differently from previous techniques, the native urethral mucosa is neither transected nor resected but is reconstructed with a direct mucosa‐to‐mucosa anastomosis. This allows a complete sparing of communicant vessels that come from the corpus spongiosum to the urethral mucosa. The technique aims to preserve the native vascularity of the urethral mucosa by enlarging the native urethral plate with a direct anastomosis at the level of the stricture, and without the need for resection. In our hands the technique was easy and reproducible, and it carried promising results in the preliminary cohort where it was applied.

Dorsal approach for double-face bulbar urethroplasty: ventral inlay plus dorsal onlay using Kulkarni one-side dissection.

Non-traumatic obliterative bulbar urethral stricture with residual urethral lumen below 3Fr is a challenging surgical scenario for reconstructive surgeons, because either anastomotic or single augmentation urethroplasty is not an option. To describe our double-face buccal mucosa graft (BMG) urethroplasty with dorsal onlay and ventral inlay relying on the vessels and nerve-sparing technique of Kulkarni's one-side dissection. We retrospectively reviewed a prospectively maintained database of patients with non-traumatic obliterative bulbar urethral strictures who underwent double-face bulbar urethroplasty with one-side dissection and dorsal onlay plus ventral inlay BMG. Patient demographics, clinical data, and follow-up were analyzed. A total of 59 patients underwent double-face urethroplasty with dorsal approach. The median age was 37years (IQR 27-49) and the median stricture length was 5cm (IQR 3.75-6). No patients had immediate post-operative complications. The overall success rate was 88% with a median follow-up of 30.9months (IQR 16.9-44.2). Two patients were treated with DVIU, and two patients with open urethral surgery. One patient developed erectile dysfunction after surgery. Age, etiology, stenosis length and previous treatment were not factors related to surgical failure. Our preliminary albeit encouraging results showed that this approach was feasible in all patients and with negligible perioperative complications. Success rate was 88%. We did not find any factors related to surgical failure. Our dorsal double-face augmented urethroplasty may be a valid alternative to the Palminteri's ventral double-face urethroplasty, especially in those patients with mid-distal bulbar or peno-bulbar urethral strictures.

To Transect or Not Transect: Results from the Scandinavian Urethroplasty Study, A Multicentre Randomised Study of Bulbar Urethroplasty Comparing Excision and Primary Anastomosis Versus Buccal Mucosal Grafting

BackgroundOpen surgical treatment of short bulbar urethral strictures (urethroplasty) is commonly performed as transecting excision and primary anastomosis (tEPA) or buccal mucosa grafting (BMG). Erectile dysfunction and penile complications have been reported, but there is an absence of randomised trials. ObjectiveTo evaluate sexual dysfunction and penile complications after urethroplasty with tEPA versus BMG. Design, setting, and participantsCentres in Finland, Sweden and Norway participated. Patients with a bulbar urethral stricture of ≤2 cm without previous urethroplasty were randomised. The primary endpoints were the degree of erectile dysfunction and penile complications. Follow-up was 12 mo. InterventionPatients were randomised to either tEPA or BMG urethroplasty. Outcome measurements and statistical analysisSexual dysfunction was measured using the International Index of Erectile Function, 5-item version (IIEF-5) and a penile complications questionnaire (PCQ) designed for this study. Continuous data were analysed using analysis of covariance and categorical data were compared using a χ2 test. Results and limitationsA total of 151 patients were randomised to either tEPA (n = 75) or BMG (n = 76). The tEPA group reported more penile complications (p = 0.02), especially reduced glans filling (p = 0.03) and a shortened penis (p = 0.001). There were no differences in postoperative IIEF-5 total scores. Recurrence rates were similar in both groups (12.9%) but the study was not designed to detect differences in recurrence rates. The PCQ is not validated, which is a limitation. ConclusionsMore patients reported penile complications after urethroplasty with tEPA than with BMG. This should be considered when choosing the operative method, and patients should be informed accordingly. Patient summaryThis study compared two common operations for repair of narrowing of the male urethra. Neither of the two methods seems to cause worsened erections. However, penile problems are more common after the transection technique than after the grafting technique.

PROSPECTIVE COMPARATIVE STUDY ON OUTCOMES OF VENTRAL ONLAY BUCCAL MUCOSAL GRAFT URETHROPLASTY WITH OR WITHOUT FIBRIN GLUE.

Objectives: We described the use of brin glue in ventral onlay Buccal Mucosal Graft Urethroplasty (BMGU) in patients of bulbar urethral stricture and compared the outcome without brin glue. Methods: Sixty patients underwent bulbar urethroplasty with ventral onlay buccal mucosal graft and were included in this study. They were divided into 2 groups with 30 in each with group 1 with brin glue and group 2 without brin glue. The urethra was mobilized from the corpora cavernosa and opened along its ventral surface. The buccal mucosal graft was applied in the standard ventral onlay technique. Intraoperative evaluation included the lengths of surgery, stricture, and admission. Patients were followed up at 3 and 6 months in the outpatient department and primary outcome measures, that is, IPSS and Qmax were recorded at each follow-up along with complications if any. Results: No signicant difference was observed in mean lengths of surgery, stricture and admission, and distribution of pre-op IPSS and Qmax between the two groups. While a signicant difference was observed in distribution of IPSS and Qmax between the two groups at 3 months and 6 months follow-up. Distribution of early complications was observed at 3 weeks follow-up after surgery with a peri catheter RGU in both groups. 3 patients were presented with a leak in group 1 and 4 patients in group 2. At 3 months 2 patients were showing complications while at 6 months follow-up only 1 patient was showing complications in each group. Conclusions: The use of brin glue represents a slight but signicant step toward the perfection of the surgical technique of bulbar urethral reconstruction.

SC72 - Long-term followup of two-sided dorsal plus ventral oral graft bulbar urethroplasty: single center experience on 216 patients

SC72 - Long-term followup of two-sided dorsal plus ventral oral graft bulbar urethroplasty: single center experience on 216 patients

Robotic Assisted Bulbar Urethroplasty: Feasibility and Preliminar Results of the First Case-Report in Brazil

During the past few years, the robotic platform has rapidly increased his use in the treatment for urologic conditions, improving ergonomics and visualization not only for abdominal surgeries such as prostatectomy and cystoprostatectomy but also, for pelvic-floor disease like urethral stricture. In this article, we describe the first use of the DaVinci platform to treat a bulbar stricture successfully through pelvic access.