Non-transecting Anastomotic Urethroplasty Research Articles

Management of urethral complications after total phallic reconstruction: a single center experience.

The aim of this study was to evaluate the outcomes of different urethroplasty procedures as well as two novel techniques, invented in our center, in management of urethral complications after total phallic reconstruction. Different urethroplasty procedures were conducted according to the urethral pathology for 36 cis-male patients with urethral complications after total phallic reconstruction including meatoplasty, visual internal urethrotomy, staged Johanson urethroplasty utilizing either buccal mucosal graft or skin graft (Tiersche-Duplay principle), non-transecting urethroplasty (Hieneke-Miiklulicz principle), excision and primary anastomosis, as well as two novel techniques: urethral closure under a suprapubic tunnel and abdominal pedicled skin flap urethroplasty. Each patient was routinely evaluated one month after surgery and every 3 months for 12 months, with clinical evaluation, uroflowmetry and post-void residual urine. With a total of 41 procedures for the 36 patients, 32 patients (88.8 %) could eventually void while standing. The success rate was highest for staged Johanson urethroplasty using split thickness skin graft, staged abdominal pedicled skin flap and excision and primary anastomosis, respectively, while it was lowest for visual internal urethrotomy (0% success) and non-transecting anastomotic urethroplasty (50% success). For staged versus one-stage procedures prospective analysis, 17 out of 26 one-stage procedures (65.4%) succeeded while 13 out of 15 staged procedures (86.6%) succeeded. Urethral complications following phalloplasty require complex procedures demanding a high level of surgical expertise. Abdominal pedicled skin flap urethroplasty is a viable option for long and recalcitrant urethral strictures.

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.

Static MRI for diagnosis of bulbous urethral strictures and assessment of spongiofibrosis grade

Introduction. Insufficient sensitivity and specificity of existing methods for diagnosing urethral stricture require more accurate methods, which may include magnetic resonance imaging (MRI).Objective. To study the possibilities of MRI to assess the extent of bulbous urethral stricture and spongiofibrosis grade.Materials & methods. The study included six men with bulbous urethral stricture, who underwent non-transecting anastomotic urethroplasty via ventral approach. Before surgery, all patients underwent retrograde urethrography according to the standard method and urethral MRI according to their own method, and their data were compared with intraoperative parameters.Results. The length of the stricture according to retrograde urethrography averaged 11.5 ± 6.3 mm, MRI — 17.8 ± 10.9 mm, intraoperative measurement — 16.7 ± 9.1 mm. There was a significant difference between the mean length of the stricture according to retrograde urethrography and the mean length according to intraoperative data (p = 0.028). There was no significant difference between the mean stricture length according to MRI data and the mean stricture length according to intraoperative data (p = 0.085). The length of spongiofibrosis according to MRI was 15.8 ± 13.6 mm on average, and 16.7 ± 12.9 mm according to intraoperative measurements. There was no significant difference between the average length of spongiofibrosis according to MRI and the average length according to intraoperative data (p = 0.092).Conclusions. MRI provides information comparable to intraoperative data on the extent of urethral stricture, location, and spongiofibrosis grade.

Urethroplasty Methods for Stricture Repair After Gender Affirming Phalloplasty: High Failure Rates in a Hostile Surgical Field

To report our experience with 71 postphalloplasty urethral strictures in order to discuss the performance characteristics of different urethroplasty techniques in urethral stricture after phalloplasty. We conducted a retrospective chart review of 85 urethroplasties performed for stricture repair in 71 patients with phalloplasty for gender affirmation between August 2017 and May 2020. Stricture location, urethroplasty type, complication rate, and recurrence rate were recorded. The most common stricture type was distal anastomotic (40/71, 56%). The most common initial repair type was excision and primary anastomosis (EPA) (33/85, 39%), followed by first-stage Johanson urethroplasty (32/85, 38%). The stricture recurrence rate after initial repair of all types was 52% (44/85). The recurrence rate of stricture after EPA was 58% (19/33). The recurrence rate after staged urethroplasty was 25% (2/8) for patients who successfully completed a first and second stage. 30% (3/10) of patients who completed a first stage and opted out of a second stage required a revision to achieve successful lifetime voiding from the surgical urethrostomy. EPA after phalloplasty has a high failure rate. Nontransecting anastomotic urethroplasty has slightly lower failure rate, and staged Johanson-type surgeries have the highest success rates after phalloplasty.

V08-06 A METHOD OF FORMING A URETHRAL ANASTOMOSIS BY VENTRAL ACCESS WITHOUT COMPLETE INTERSECTION OF THE BODY SPONGIOSUM

You have accessJournal of UrologyCME1 Apr 2023V08-06 A METHOD OF FORMING A URETHRAL ANASTOMOSIS BY VENTRAL ACCESS WITHOUT COMPLETE INTERSECTION OF THE BODY SPONGIOSUM Andrey Bogdanov, Magomed Katibov, Eugeny Veliev, and Aleksandra Poliakova Andrey BogdanovAndrey Bogdanov More articles by this author , Magomed KatibovMagomed Katibov More articles by this author , Eugeny VelievEugeny Veliev More articles by this author , and Aleksandra PoliakovaAleksandra Poliakova More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Dorsal techniques of non-transecting anastomotic urethroplasty have certain disadvantages. Therefore, we have proposed a new technique of non-transecting anastomotic urethroplasty using ventral access. METHODS: 47 men with strictures of the bulbous urethral segment of different etiologies underwent anastomotic urethral plastic surgery without full mobilization and intersection of the dorsal semicircle of the spongy body by one surgeon in the clinic of urology and surgical andrology from January 2016 to March 2022. By origin, strictures were iatrogenic – 19 (40.4%), post-infectious -22 (46.8%) and post-traumatic (blunt trauma of the perineum) – 6 (12.7%). A significant proportion of patients, 32(68%), had previously undergone surgical treatment of strictures, including internal optical urethrotomy and urethral bougienage. The average age of patients was 59 years. All patients of this group underwent our technique. RESULTS: The average length of the strictures was 1.7 cm. The average duration of the operation accounted for 106 minutes. The average volume of blood loss was 181 ml. The median volumetric maximum urination rate was estimated 3 months after surgeries and accounted for 17.7 ml/sec. The average amount of points on the ICEF scale before and after surgical treatment did not change significantly, its median before surgery was 15 points, 3 months after surgery – 16. During the entire follow-up period, only 3 patients (6.3%) showed signs of constriction in the area of urethral anastomosis, confirmed by urethrography, uroflowmetry and also by the data of urethral calibration using a Foley catheter. Two patients already were operated with buccal graft, third still under observation. CONCLUSIONS: Considering the objective reduction in the volume of direct surgical trauma, partial preservation of innervation and blood supply to the urethra, due to the absence of mobilization of the dorsal surface of the spongy body, the absence of early and late postoperative complications, satisfactory quality of urination (93.7%), preservation of the initial level of erectile function, a low number of relapses (6.3%) during long follow–up periods, as well as the fact that this technique was carried out despite the different degree of spongiofibrosis - this variant of urethral plastic surgery after additional studies and significant observation periods can be useful. Source of Funding: there is no source of funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e750 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrey Bogdanov More articles by this author Magomed Katibov More articles by this author Eugeny Veliev More articles by this author Aleksandra Poliakova More articles by this author Expand All Advertisement PDF downloadLoading ...

Urethroplasty technological changes for the treatment of male urethral stricture

Urethroplasty is an important method to treat male urethral stricture. Nowadays, urethroplasty mainly includes two types: anastomotic urethroplasty and substitution urethroplasty. Anastomotic urethroplasty mainly includes primary anastomosis urethroplasty and non-transecting anastomotic urethroplasty. Substitution of urethroplasty mainly includes staged urethroplasty and one-stage urethroplasty. Substitution materials always are chosen by pedicle skin flap and free mucosal graft. Anastomosis urethroplasty has shown good results in short bulbar urethral stricture and posterior urethral stricture after pelvic fracture. Among them, non-transecting anastomosis urethroplasty has become a new surgical method for iatrogenic, single, short or non-occluded stenosis. At present, the one-stage substitution urethroplasty is the most widely used. However, there are still many complicated cases that must be solved by staged urethroplasty. Pedicle skin flap and oral mucosa are widely used as substitutes at present. How to select the best surgical procedure and substitute materials individually would be the problem worthy of attention in the future. Accumulating more long-term follow-up data is helpful for objective comparison of various surgical procedures and grafts.

V09 - Repair of long anterior urethral strictures combining a non-transecting anastomotic urethroplasty and an urethroplasty with buccal mucosal grafts in a dorso-lateral position using the Kulkarni technique

V09 - Repair of long anterior urethral strictures combining a non-transecting anastomotic urethroplasty and an urethroplasty with buccal mucosal grafts in a dorso-lateral position using the Kulkarni technique

Анастомотическая уретропластика без пересечения спонгиозного тела

The review analyzes the results of using non-transecting anastomotic urethroplasty in men with urethral strictures. Identified 14 original studies using this technique: 13 foreign and 1 Russian. In total, this technique was applied in 704 patients. This technique was used in 85% of cases with bulbar urethral stricture, in 15% - with posterior stricture.The average length of the urethral stricture in all studies was less than 2 cm, except for two works, where the average stricture length was 2.3 cm and 3.9 cm, respectively. This technique is equally successfully applied in all etiological variants of urethral stricture. The incidence of postoperative complications in all studies using non-transecting anastomotic urethroplastyaveraged 13.7%.Postoperative complications were mostly mild and corresponded to G1 according to Clavien-Dindo classification.According to 10 out of 14 studies that evaluated the effect of surgical treatment on the occurrence of erectile dysfunction (ED), the incidence of ED de novo was on average 13.4%. The success of treatment with the use of non-transecting anastomotic urethroplastyaveraged 95% (82-100%) with a median postoperative follow-up of 27 months (6-64 months). In 4 out of 14 studies, an additional comparison was transecting versus non-transecting techniques. Non-transecting technique was not inferior to transecting technique by any criterion, but, on the contrary, exceeded it in a number of indicators, including the dynamics of sexual function after surgery.On the basis of available studies on the use of non-transecting anastomotic urethroplasty, this technique should be recognized as a highly efficient and reasonably safe method for treating short urethral strictures and recommended for widespread clinical use.

One-stage urethroplasty for strictures at a rural hospital

Introduction: St Mary’s Mission Hospital manages many inflammatory and traumatic urethral strictures. Previously, we treated strictures with dilatation, but high recurrence and poor patient satisfaction necessitated adoption of reconstructive procedures since 2017.Objective: To review the scope, outcome and complications of urethroplasties using data collected prospectively.Methods: All cases of one-stage urethroplasty were included. Patient biodata and pre-operative adverse factors were collected and analyzed.Results: 23 male patients ranging in age from 24 to 74 years were studied: 9 strictures were inflammatory (40%), 9 were traumatic (40%), 3 (20%) were recurrent. Nineteen strictures were in the bulbar urethra (83%), 2 were cases of penile strictures and 1 case each of pan-urethral stricture and pelvic floor urethral distraction defect. Of the 23 procedures, 13 were simple anastomosis (57%), 5 were dorsal buccal mucosa graft (BMG) urethroplasty (22%), 2 were cases of non-transecting anastomotic urethroplasty, and 1 case each of ventral BMG urethroplasty and Johansson’s and Kulkarni’s panurethroplasty. The overall complication rate was 40% (9 patients). Four patients (17%) had recurrence; 2 had fistula and 1 case each of persistent UTI, erectile dysfunction and periurethral abscess. Three of the four recurrences had undergone BMG urethroplasty. All cases of simple anastomosis had no recurrence.Conclusion: Our centre has embraced diverse urethroplasties for a wide scope of patients. This study found a significant complication rate for substitution urethroplasties, suggesting a need for careful patient selection and an improvement in technique.Keywords: Stricture, Urethroplasty, One-stage, Complications, Outcome

The Benefits of Using a Small Caliber Ureteroscope in Evaluation and Management of Urethral Stricture.

Introduction and Objective The proper evaluation of urethral strictures is an essential part of the surgical planning in urethral reconstruction. The proper evaluation of the stricture can be challenging in certain situations, especially when the meatus is involved. We propose that the use of a small caliber ureteroscope (4.5 Fr and 6.5 Fr) can offer additional help and use for the surgical planning in urethroplasty. Methods We prospectively collected data on 76 patients who underwent urethroplasties in Kulkarni Reconstructive Urology Center, Pune, India and Thunder Bay Regional Health Sciences Center, Thunder Bay, Canada. Patients had retrograde and micturition urethrograms performed preoperatively. The stricture was assessed visually using a 6.5 Fr ureteroscope. If the stricture was smaller than 6.5 Fr, we attempted using the 4.5 Fr ureteroscope. In nonobliterated strictures, we attempted bypassing the stricture making sure not to dilate the stricture. A glide wire would be passed to the bladder under vision. Stricture length, tissue quality, presence of other proximal strictures, false passages, and bladder tumors or stones would be assessed visually. If the penile stricture was near obliterative (smaller than 4.5 Fr caliber), a two-staged procedure is elected to be performed. For proximal bulbar strictures, if the urethral caliber is less than 4.5 Fr and the stricture length is less than 1 cm, we perform a nontransecting anastomotic urethroplasty (NTAU). If the stricture length is >1 cm, we perform a double-face augmented urethroplasty (DFAU). If the urethral caliber is >4.5 Fr and particularly those who are sexually active, ventral inlay with buccal mucosal grafts (BMGs) is performed. In mid to distal bulbar strictures, if the urethral caliber is >4.5 Fr, our procedure of choice is dorsal onlay with BMG. For those with urethral caliber <4.5 Fr and a stricture less than 1 cm, we perform a NTAU. For strictures longer than 1 cm, we perform a DFAU. With the exception of trauma, we very rarely transect the urethra. For panurethral strictures, we almost exclusively perform Kulkarni one-sided dissection. Results Urethroscopy was performed in 76 patients who presented for urethroplasty from July 2014 to September 2014 (in Pune) and between April 2016 and September 2017 (in Thunder Bay). Bypassing the stricture was achieved in 68 patients (89%) while it was unsuccessful in 8 patients (11%). In all unsuccessful urethroscopies, the stricture was near obliterative <4.5 Fr. Our surgical planning changed in (13) 17% of the cases. Out of 43 bulbar strictures, the decision was changed in (9) 21% where we performed 4 DFAU, 3 AAU (augmented anastomotic urethroplasty), and 2 EAU (end anastomotic urethroplasty). In 13 penile strictures, we opted for staged urethroplasty including 3 Johansons and 1 first-stage Asopa in 30.7%. In 20 panurethral urethroplasties, 1 patient (5%) had a urethral stone found in a proximal portion of the bulbar urethra distal to a stricture ring that was removed using an endoscopic grasper. Conclusion The use of the small caliber ureteroscope can help in evaluation of the stricture caliber, length, and tissue quality. The scope can also aid in placing a guide wire, evaluating the posterior urethra, and screening for urethral or bladder stones. It can also improve the preoperative patient counselling and avoid unwanted surprises.

Non-Transecting Techniques Reduce Sexual Dysfunction After Anastomotic Bulbar Urethroplasty: Results of a Multi-Institutional Comparative Analysis

PurposeThe purpose of this multi-institutional study is to compare outcomes of transecting and non-transecting anastomotic bulbar urethroplasty. Materials and MethodsThis was a retrospective multi-institutional review of 352 patients undergoing either transecting or non-transecting anastomotic bulbar urethroplasty performed by one of four reconstructive urologists from September 2003 to March 2017. Study outcomes were urethroplasty success (defined as urethral patency >16Fr on cystoscopy), de novo sexual dysfunction assessed at 6-months (defined as ≥5-point change in SHIM or patient reported adverse change) and 90-day complications (Clavien ≥2). Comparison between transecting and non-transecting cohorts were made using the Mantel–Cox test, t-test or Chi-square when appropriate. Results352 patients with a mean stricture length of 1.7cm (0.5-5cm) underwent either a transecting (n=258) or non-transecting (n=94) anastomotic bulbar urethroplasty. Overall success was 94.9% at a mean follow-up of 64.2 months (6-170). 7.1% of patients experienced a 90-day complication and 11.6% reported sexual dysfunction. When comparing transecting and non-transecting techniques there was no difference in success (93.8% vs. 97.9%; p=0.18) (Mantel-Cox) or postoperative complications (8.1% vs. 4.3%; p=0.25). Patients undergoing transecting anastomotic urethroplasty were more likely to report an adverse change in sexual function (14.3% vs. 4.3%; p=0.008). On multivariate analysis, only transecting urethroplasty (p=0.01) was associated with sexual dysfunction while age (p=0.29), stricture length (p=0.42), etiology (p=0.99) and surgeon (p=0.88) were not. ConclusionsAnastomotic urethroplasty is a highly effective surgery with relatively minimal associated morbidity. Non-transecting anastomotic urethroplasty compares quite favorably to the transecting technique and likely reduces the risk of associated sexual dysfunction.

Preliminary clinical study on non-transecting anastomotic bulbomembranous urethroplasty.

This study aims to investigate the effect of non-transecting anastomotic urethroplasty for treatment of posterior urethral stricture. A total of 23 patients with traumatic posterior urethral stricture were enrolled and then divided into two groups. In one group, 12 patients underwent non-transecting anastomotic urethroplasty. In the other group, 11 patients underwent conventional posterior urethra end-to-end anastomosis. The effect of operation was evaluated using the following parameters: the bleeding amount during operation, operation time, IIEF-5 scores after operation, maximum flow rate (Qmax), and rating scale of quality of life (QoL). The comparison between the conventional posterior urethra end-to-end anastomosis group and the non-transecting anastomotic urethroplasty group showed no significant difference with regard to average operation time. However, a significant difference was observed between the groups with regard to the bleeding amount during operation. The patients in the group of non-transecting anastomotic urethroplasty urinated smoothly after the removal of catheter. Meanwhile, one patient from the group of conventional posterior urethra end-to-end anastomosis had difficulty urinating after the removal of catheter. Furthermore, significant differences in the operation time, bleeding amount during operation, IIEF-5 scores after operation, and rating scale of QoL were observed, whereas no significant difference was observed between urine flow rates of the two groups after operation. Overall, nontransecting anastomotic urethroplasty is effective for posterior urethra reconstruction, and it can reduce the occurrence rate of erectile dysfunction after operation.

PD34-01 ANASTOMOTIC BULBAR URETHROPLASTY: TO TRANSECT OR NOT TO TRANSECT?

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III1 Apr 2017PD34-01 ANASTOMOTIC BULBAR URETHROPLASTY: TO TRANSECT OR NOT TO TRANSECT? Dave Chapman, Adam Kinnaird, Jon Witten, and Keith Rourke Dave ChapmanDave Chapman More articles by this author , Adam KinnairdAdam Kinnaird More articles by this author , Jon WittenJon Witten More articles by this author , and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1524AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Anastomotic urethroplasty is an effective but occasionally controversial treatment for short bulbar urethral strictures. Non-transecting variations of anastomotic urethroplasty were created in part to address this controversy. The objective of this study is to assess current outcomes of anastomotic urethroplasty and compare outcomes of transecting and non-transecting techniques. METHODS 171 patients with complete follow-up underwent anastomotic bulbar urethroplasty from September 2003 to May 2016. Patient age, stricture length, location, etiology, 90-day complications and semi-quantitative assessment of sexual dysfunction were recorded. The primary (objective) outcome was success defined as urethral patency >16Fr on routine follow-up cystoscopy. Secondary outcome measures included 90-day complications (Clavien ≥2) and de novo sexual dysfunction assessed at 6 months. Statistical comparison between transecting and non-transecting cohorts was made using Cox Regression Analysis and Chi-square when appropriate. RESULTS One hundred and thirty patients underwent transecting anastomotic urethroplasty while 41 had a non-transecting anastomotic urethroplasty. Mean stricture length was 1.5±0.5cm (range 1-3) with a mean patient age of 43.0±18.0 years. 78.9% of patients failed prior endoscopic treatment (135/171) and 2.4% failed prior urethroplasty (4). Overall there was a 98.2% (168/171) success rate with a mean follow-up of 74.9(±46.7) months. 7.0% (12/171) of patients experienced a 90-day postoperative complication of Clavien ≥2 including 2.9% wound-related complications (5), 1.8% scrotal hematomas (3), 1.8% UTI (3), and 0.6% urethral bleeding (1). 9.9% reported an adverse change in sexual function including 6.4% erectile dysfunction (11), 1.8% ejaculatory dysfunction (3), 1.2% painful erection (2), and 0.6% chordee (1). When comparing transecting and non-transecting technique success using Cox Regression analysis there was no difference in urethroplasty success (97.7% vs. 100%; p=0.63) and no difference in postoperative complications (7.7% vs. 4.9%; p=0.73) but patients undergoing transecting anastomotic urethroplasty were more likely to report an adverse change in sexual function (13.1%; vs. 0%; p=0.013). CONCLUSIONS Anastomotic urethroplasty remains a highly effective treatment for short-segment bulbar urethral strictures with relatively minimal associated morbidity. Newer non-transecting anastomotic urethroplasty techniques appear to compare favorably in the short-term and may reduce the risk of associated sexual dysfunction. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e657 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Dave Chapman More articles by this author Adam Kinnaird More articles by this author Jon Witten More articles by this author Keith Rourke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

FRII-15 ‘EVOLUTION OF INNOVATION’: HISTORICAL PERSPECTIVES ON THE MANAGEMENT OF URETHRAL STRICTURE DISEASE

You have accessJournal of UrologyHistory of Urology: History Forum1 Apr 2017FRII-15 ‘EVOLUTION OF INNOVATION’: HISTORICAL PERSPECTIVES ON THE MANAGEMENT OF URETHRAL STRICTURE DISEASE Devang Desai, Pankaj Joshi, Hazem Orabi, Sandesh Surana, and Sanjay Kulkarni Devang DesaiDevang Desai More articles by this author , Pankaj JoshiPankaj Joshi More articles by this author , Hazem OrabiHazem Orabi More articles by this author , Sandesh SuranaSandesh Surana More articles by this author , and Sanjay KulkarniSanjay Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2464AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urethral stricture is a prevalent and challenging urological condition. Management has evolved over the last century, specifically with the advent of oral mucosal grafts for urethroplasty. We review the history of urethral stricture treatment. METHODS A literature search of medical texts, journal articles and historical texts was performed pertaining to history of urethral strictures. RESULTS Urethra originates from the Greek word ourein ‘urinate'. Urethral stricture was first depicted in Hindoo scriptures (6th century BC). Susruta described in Ayurveda the treatment by means of graduated dilators of metal or wood. Ambrose Pare in his depictions of urethrotomy mentions ‘A silver weir, sharp at the upper end, is to be passed in as far as the obstruction, then by oft thrusting it in and out, it may wear and make plain the resisting caruncles'. In 1894, Sapezho first used oral mucosa in urethroplasty. Humby revived the use in 1941. This landmark discovery revolutionized urethral surgery. Several modern innovations have since been described: staged repair (Johanson 1953), dorsal onlay (Barbagli 1996), ventral onlay (Morey, McAnnich 1996), dorsal inlay penile (Hayes and Malone1999), dorsal inlay bulbar (Asopa 2001), panurethral stricture management (Kulkarni 2000), nerve sparing and bulbospongiosus sparing bulbar reconstruction (Barbagli 2008), Enterourethroplasty (Mundy 2010), Non-transecting anastomotic urethroplasty (Mundy 2015). Over this period the perineal incision has evolved from a lamda to a midline incision. Current advances include liquid mucosal grafts; tissue engineering and stem cells, which would halt the process of fibrosis and prevent stricture formation. Posterior urethral injuries have traditionally been managed by anastomotic urethroplasty. Pierce 1962 performed total abdominal pubectomy. Paine & Coombs 1968 performed anastomotic urethroplasty after excision of scar by abdominal approach. 1973 Waterhouse developed abdominoperineal approach. 1976 Turner-Warwick used omental wrap for transpubic primary anastomosis. Webster & Goldwasser 1986 performed perineal anastomotic urethroplasty using inferior pubectomy. Kulkarni 2010 described etiology and management of posterior urethral injuries. Currently a progressive stepwise approach has been used for managing posterior urethral injuries. CONCLUSIONS Management of urethral stricture patients has evolved over the last century. The use of oral mucosal grafts is still one the greatest advancements. As we continue to better understand urethral strictures, we hope to make even greater strides over the next decade. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1072 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Devang Desai More articles by this author Pankaj Joshi More articles by this author Hazem Orabi More articles by this author Sandesh Surana More articles by this author Sanjay Kulkarni More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V65 Non-transecting anastomotic urethroplasty is a new type of urethroplasty for short bulbar urethral stricture

V65 Non-transecting anastomotic urethroplasty is a new type of urethroplasty for short bulbar urethral stricture

Non-transecting anastomotic urethroplasty (surgical atlas)

Non-transecting anastomotic urethroplasty – is three types of urethroplasty, which are united on the principle resection of bulbar urethra with sparing of corpus spongiosum and antegrade blood flow through it. The article describes the surgical technique of urethroplasty: dorsal strictureplasty by Heineke–Mikulicz; strictureplasty by Mundy; vessel-sparing anastomotic urethroplasty by Jordan. Obligatory conditions of the non-transecting anastomotic urethroplasty are a non traumatic etiology, length of the stricture not more than 1–1.5 cm, and its localization in the proximal bulbar urethra. Strictureplasty by Heineke–Mikulicz is a dorsal longitudinal incision of the urethra on the area of stricture and subsequent suturing the defect transversely. Strictureplasty by Mundy is a dorsal longitudinal urethrotomy, excision of the affected mucosa inside the lumen of the urethra and transversely urethral closure according to Heineke–Mikulicz, s principle. Vessel-sparing anastomotic urethroplasty by Jordan is circular excision of the urethral mucosa without crossing of corpus spongiosum and incoming into it bulbar arteries and thereby preserving the antegrade blood flow through the urethra.

PD22-02 TRANSECTED VS NON-TRANSECTED BULBAR URETHROPLASTY RESULTS IN SIMILAR STRICTURE RESOLUTION RATE IN PRIMARY REPAIR OF BULBAR URETHRAL STRICTURES

You have accessJournal of UrologyTrauma/Reconstruction: Urethral Reconstruction (including Stricture) III1 Apr 2015PD22-02 TRANSECTED VS NON-TRANSECTED BULBAR URETHROPLASTY RESULTS IN SIMILAR STRICTURE RESOLUTION RATE IN PRIMARY REPAIR OF BULBAR URETHRAL STRICTURES Kirk Anderson, Catherine Cooper, Dmitriy Nikolavsky, and Brian Flynn Kirk AndersonKirk Anderson More articles by this author , Catherine CooperCatherine Cooper More articles by this author , Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author , and Brian FlynnBrian Flynn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1444AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are a wide variety of techniques used in the repair of bulbar urethral strictures. The decision to perform transection vs. non-transection of the corpus spongiosum during urethoplasty is based on stricture characteristics and surgeon preference. A potential benefit of non-transecting technique is preservation of blood supply distal to the site of stricture. The purpose of this study is to review the stricture resolution rate of transecting vs non-transecting urethroplasty utilized by a single surgeon (BJF) to repair bulbar urethral strictures. METHODS A retrospective review was done of 342 patients who underwent anterior urethroplasty performed by a single surgeon over the previous 11 years. Patients were then excluded from further analysis if there had been prior urethroplasty, stricture location outside the bulbous urethra, or age <18 years. In the transected group, surgical techniques used included excision and primary anastomosis (EPA) and augmented anastomosis. In the non-transected group, surgical techniques used included non-transecting anastomotic urethroplasty and dorsal, ventral, or combination dorsal-ventral buccal grafting. The decision which surgical technique to employ was based on stricture etiology, length and surgeon preference. The primary end-point was stricture resolution in transected vs. non-transected bulbar urethroplasty. Success was defined as freedom from secondary procedures including dilation, urethrotomy, or repeat urethroplasty. RESULTS One-hundred and fifty-two patients met inclusion criteria. Mean patient age is 42 years and mean follow-up is 63 months. Primary and secondary outcomes are summarized in Table 1. The most common etiologies are idiopathic and trauma occurring in 59% and 30%, respectively, in the transected group and 60% and 32%, respectively, in the non-transected group. CONCLUSIONS Urethroplasty can be accomplished utilizing a variety of surgical techniques with durable success rates. In this series, transecting and non-transecting bulbar urethroplasty resulted in similar stricture resolution rate. Additional studies are needed to determine if differences may exist in sexual function outcomes and long-term success. Transected Non-Transected p-value Number 102 50 Success 83% 84% 0.92 Stricture Length (range) 2.3cm (0.3-8cm) 3.9 (1-10cm) <0.01 Prior DVIU 51% 54% 0.49 Mean f/u (months, range) 72 (18-137) 45 (2-135) <0.01 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e476-e477 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kirk Anderson More articles by this author Catherine Cooper More articles by this author Dmitriy Nikolavsky More articles by this author Brian Flynn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Bulbar urethroplasty

To transect or not to transect the bulbar urethra in nontraumatic urethral strictures still remains an issue that is open to debate. Herewith, we evaluate and compare the results of these two different options in the treatment of bulbar urethral strictures. In 404 patients, bulbar urethroplasty using transecting techniques (end-to-end anastomosis and augmented anastomotic repair) provided a success rate ranging from 90 to 98.6%. In 522 patients, bulbar urethroplasty using nontransecting techniques (nontransecting anastomotic urethroplasty and simple oral grafting techniques) provided approximately the same success rate, ranging from 81.8 to 100%. Future studies, including more homogenous series of patients and subjective evaluation of urinary and sexual complications after repair, are necessary to surely establish the gold standard of treatment for nontraumatic strictures located in the proximal bulbar urethra.

614 Non-transecting anastomotic bulbar urethroplasty

614 Non-transecting anastomotic bulbar urethroplasty