Treatment Of Bulbar Urethral Strictures Research Articles

The urinary and sexual outcomes of buccal mucosal graft urethroplasty versus end-to-end anastomosis: a systematic review with meta-analysis.

The urinary and sexual outcomes after urethroplasty may be a concern for patients, but there are still some controversies regarding the consequences of buccal mucosal graft urethroplasty (BMG) in terms of erectile dysfunction (ED). This meta-analysis aimed to compare urinary and sexual outcomes of BMG and end-to-end urethroplasty (EE). The PubMed, Web of Science, Cochrane, and Embase databases were searched until February 31, 2023. Data extraction and quality assessment were performed by 2 designated researchers. Dichotomous data were analyzed as odds ratios with 95% confidence intervals (CIs). Heterogeneity across studies was assessed by the I2 quantification, and publication bias using Begg's and Egger's tests. Meta-analysis was performed using RevMan software. Outcomes included stricture recurrence, ED, penile complications, and voiding symptoms. Eighteen studies, including 1648 participants, were included in our meta-analysis. The meta-analysis revealed that there was no significant difference in stricture recurrence (OR = 0.74; 95% CI, 0.48-1.13; P = .17) and voiding symptoms (OR = 1.12; 95% CI, 0.32-3.88; P = .86) between the BMG group and the EE group. BMG was associated with lower risk of penile complications (OR = 0.40; 95% CI, 0.24-0.69; P = .001) and ED (OR = 0.53, 95% CI, 0.32-0.90, P = .02). The study may help clinicians choose procedures that achieve better recovery of the urological and sexual function in the treatment of urethral stricture. This meta-analysis is the first to evaluate the urinary and sexual outcomes of BMG vs EE. A limitation is that most of the included studies were retrospective cohort studies. BMG is as effective as EE in the treatment of bulbar urethral stricture, but BMG has fewer complications and ED than EE.

Non-transecting urethroplasty in patients with bulbar urethral strictures shorter than three centimeters

Purpose This study aimed to compare the success and postoperative complication rates of the novel non-transecting urethroplasty (NTU) technique and conventional excision-primary anastomosis (EPA) in the surgical treatment of short bulbar urethral strictures. Material and methods Data of the patients who underwent excision-primary anastomosis or NTU procedures at our center for the surgical treatment of bulbar urethral strictures shorter than 3 cm between January 2010 and December 2018 were retrospectively reviewed. Results Forty-seven patients fulfilled the eligibility criteria for this study. Among these patients, 22 underwent NTU procedure while 25 underwent EPA. There was no difference between the two groups regarding age, stricture length, etiology, past surgical history, and duration of follow-up. The surgical success rates were 88% and 87,2% in the NTU and EPA groups, respectively (p = 0,603). The complication rates were 12% and 13,6% in NTU and EPA groups, respectively. Two groups were similar concerning complication rates (p = 0,603). Conclusion The novel NTU and conventional EPA techniques are similar regarding surgical success and complication rates in the surgical treatment of bulbar urethral strictures shorter than three centimeters.

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

Surgical treatment of bulbar urethral strictures: tips and tricks.

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.

P-08-6 Direct Visual Internal Urethrotomy as Primary Treatment for Bulbar Urethral Strictures: Outcomes and Predictors of Failure

P-08-6 Direct Visual Internal Urethrotomy as Primary Treatment for Bulbar Urethral Strictures: Outcomes and Predictors of Failure

MP35-02 IS URETHROPLASTY REALLY MORE COST-EFFECTIVE THAN URETHRAL DILATATION FOR PRIMARY BULBAR URETHRAL STRICTURES?

INTRODUCTION AND OBJECTIVE: Urethroplasty is the gold-standard curative treatment for bulbar urethral strictures. Nevertheless many are still managed by urethrotomy/dilatation. This study evaluates the cost-effectiveness of urethroplasty compared to urethral dilatation within the framework of the UK NHS funding system. METHODS: All untreated bulbar strictures managed by urethroplasty or urethral dilatation between January and December 2013 were included. Our prospective outcomes database was retrospectively searched to identify patient and stricture characteristics, treatment outcome and management of failures. Cost of urethroplasty was £2964. Dilatation done as a day case procedure in the operating theatre cost £934. (Dilatation as an outpatient costs £194 for dilatation alone or £317 including cystoscopy). All patients were followed up for 5 years. Cost of treatment per patient over the entire period from the initial procedure to date was calculated. RESULTS: 38 patients with untreated bulbar strictures were managed by dilatation (GroupA) and 62 by urethroplasty (GroupB – anastomotic n=6; non-transecting anastomotic n=28; buccal graft augmentation n=28). 11(29%) patients in groupA and 58(93.5%) in GroupB required no further intervention during follow-up. 16 patients in GroupA required 29 further dilatations between them (mean 1.8each) costing £2627 per patient. 15 patients went on to have a urethroplasty, 11 after the first dilatation. Between them these 15 had 19 dilatations costing £4147per patient. Cost of managing a patient after a single failed dilatation (by further dilatation or urethroplasty) was £3583 (£2304 if outpatient dilatation). Total cost per patient of managing bulbar strictures by urethral dilatation as inpatient was £2816 (£1728 as outpatient incl cystoscopy). 4 patients in GroupB developed recurrent strictures. One underwent redo-urethroplasty. The other 3 underwent 7 dilatations between them. Total cost of managing strictures by urethroplasty was £3117per patient. CONCLUSIONS: Overall costs per patient of managing bulbar strictures in hospital by urethral dilatation and primary urethroplasty are comparable (£2816 vs £3117). However, if the first dilatation fails, any further management, particularly urethroplasty, becomes less cost-effective than immediate urethroplasty. If, however, inpatient urethroplasty is compared with outpatient dilatation then dilatation becomes considerably more cost-effective over that 5 year period. Patient and stricture selection are therefore extremely important before embarking on a treatment strategy for bulbar strictures. Source of Funding: None

Treatments of 1242 bulbar urethral strictures: multivariable statistical analysis of results.

We investigated the success rate of different surgical techniques for bulbar stricture repair. Retrospective study of patients with bulbar urethral strictures treated using different techniques. The primary outcome of the study was to evaluate the overall results of treatment (success vs. failure); the secondary outcome was to evaluate the outcome according to any surgical technique. Cysto-urethrography was performed 1month following surgery. Patients underwent clinical evaluation, uroflowmetry and residual urine measurement every 6months for 2years after surgery and later once on year. When patient showed obstructive symptoms, Qmax < 12ml/s, the urethrography was repeated. Patients who underwent further treatment for recurrent stricture were classified as failures. A bivariable and multivariable statistical analysis was performed. Overall, 1242 patients were included in the study with mean age 40years (range 12-84). Median stricture length was 4cm (range 1-8). The median follow-up was 103months (range 12-362). Over 1242 patients, 916 (73.8%) were success and 326 (26.2%) failures. Fourteen different surgical techniques showed a success rate ranging from 87.5 to 14.3%. The multivariable analysis showed that stricture length was an independent predictor factors for failure: p < 0.0001 CI 1146-1509. End-end anastomosis and oral mucosa graft urethroplasty are independent predictor factor of success after internal urethrotomy failure. Our results showed that treatment of bulbar urethral stricture is satisfactory on 73.8% of patients, but with a wide range of success rate (from 14.3 to 87.5%) using different techniques. Oral mucosa is greatly superior to the skin as substitute material.

P57 - Treatment of bulbar urethral strictures: Evaluation of the results at long-term follow-up in 1247 patients

P57 - Treatment of bulbar urethral strictures: Evaluation of the results at long-term follow-up in 1247 patients

Allium Stents: A Novel Solution for the Management of Upper and Lower Urinary Tract Strictures.

Stents are widely use in endoscopic urological procedures. One of the most important indications is the treatment of urinary tract strictures. Allium™ Medical has introduced several types of stents for the treatment of different types of urinary tract strictures, based on anatomic location. All the stents are made of nitinol and coated with a co-polymer that reduces encrustations. These stents are self-expandable and have a large caliber and a high radial force. They have different shapes, designed especially for the treatment of each type of stricture. One of the most important features of Allium-manufactured stents is the ease of removal, due to their special unraveling feature. The company has introduced the Bulbar Urethral Stent (BUS) for treatment of bulbar urethral strictures; a rounded stent available in different lengths. Initial data on 64 patients with bulbar urethral stricture treated with the BUS showed a significant improvement in symptoms, with minimal complications and few adverse events. For treatment of prostate obstruction in patients unfit for surgery or unwilling to undergo a classical prostatic surgery, the Triangular Prostatic Stent (TPS) was introduced, which has a triangular shape that fits in the prostatic urethra. Its body has a high radial force attached to an anchor (which prevents migration) through a trans-sphincteric wire (which reduces incontinence rate). Initial data on 51 patients showed significant improvement in symptoms and in urinary peak flow rate, with a relatively small number of complications. The Round Posterior Stent (RPS) was designed for treatment of post radical prostatectomy bladder neck contracture. This short, round stent has an anchor, which is placed in the bladder neck. This stent being relatively new, the clinical data are still limited. Ureteral strictures can be treated with the Ureteral Stent (URS), which is round-shaped, available in different lengths, and has an anchor option (for very distal or very proximal strictures). We have previously published data on 107 URSs inserted in patients with ureteral stricture due to several etiologies, including patients who failed previous treatment. All patients were asymptomatic for a long period of follow-up after stent removal, with only one case of re-stenosis. In this paper, we review the urological “covered” stents produced by Allium Medical with the relevant clinical data available at the present time.

Surgical Tips and Tricks During Urethroplasty for Bulbar Urethral Strictures Focusing on Accurate Localisation of the Stricture: Results from a Tertiary Centre

BackgroundThere are several techniques for characterising and localising an anterior urethral stricture, such as preoperative retrograde urethrography, ultrasonography, and endoscopy. However, these techniques have some limitations. The final determinant is intraoperative assessment, as this yields the most information and defines what surgical procedure is undertaken. ObjectiveWe present our intraoperative approach for localising and operating on a urethral stricture, with assessment of outcomes. Design, setting, and participantsA retrospective review of urethral strictures operated was carried out. All patients had a bulbar or bulbomembranous urethroplasty. All patients were referred to a tertiary centre and operated on by two urethral reconstructive surgeons. Surgical procedureIntraoperative identification of the stricture was performed by cystoscopy. The location of the stricture is demonstrated externally on the urethra by external transillumination of the urethra and comparison with the endoscopic picture. This is combined with accurate placement of a suture through the urethra, at the distal extremity of the stricture, verified precisely by endoscopy. Outcome measures and statistical analysisClinical data were collected in a dedicated database. Intraoperative details and postoperative follow-up data for each patient were recorded and analysed. A descriptive data analysis was performed. Results and limitationsA representative group of 35 male patients who had surgery for bulbar stricture was randomly selected from January 2010 to December 2013. Mean follow-up was 13.8 mo (range 2–43 mo). Mean age was 46.5 yr (range 17–70 yr). Three patients had undergone previous urethroplasty and 26 patients had previous urethrotomy or dilatation. All patients had preoperative retrograde urethrography and most (85.7%) had endoscopic assessment. The majority of patients (48.6%) had a stricture length of >2–7cm and 45.7% of patients required a buccal mucosa graft. There were no intraoperative complications. Postoperatively, two patients had a urinary tract infection. All patients were assessed postoperatively via flexible cystoscopy. Only one patient required subsequent optical urethrotomy for recurrence. ConclusionsOur intraoperative strategy for anterior urethral stricture assessment provides a clear stepwise approach, regardless of the type of urethroplasty eventually chosen (anastomotic disconnected or Heineke-Mikulicz) or augmentation (dorsal, ventral, or augmented roof strip). It is useful in all cases by allowing precise localisation of the incision in the urethra, whether the stricture is simple or complex. Patient summaryWe studied the treatment of bulbar urethral strictures with different types of urethroplasty, using a specific technique to identify and characterise the length of the stricture. This technique is effective, precise, and applicable to all patients undergoing urethroplasty for bulbar urethral stricture.

Plastic end-to-end treatment of bulbar urethral stricture.

For bulbar urethral strictures up to 2.5 cm in length, the one-stage urethral plastic surgery with stricture excision and direct end-to-end anastomosis remains the best procedure to guarantee a high success rate.This retrospective review shows the results of 21 patients who underwent bulbar end-to-end anastomosis from 2010–2013.In 20 cases (95.3%) good results were archived. The criteria of success were identified by pre- and postoperative radiological diagnostics and uroflowmetry.

The Augmented Nontransected Anastomotic Urethroplasty for the Treatment of Bulbar Urethral Strictures

The augmented anastomotic urethroplasty (AAU) combines resection of a urethral stricture and an onlay graft. The augmented nontransected anastomotic urethroplasty (ANTA) is a modification of the AAU and involves complete stricture excision without transecting the spongiosum. This is a retrospective cohort study comparing ANTA with dorsal onlay buccal grafting (DOBG) for bulbar urethral strictures. Medical records between 2005 and 2010 were reviewed. A cross-sectional questionnaire was used to assess long-term outcomes. Medians and interquartile ranges are reported. Forty-four men (23 DOBG, 21 ANTA) with a median follow-up of 2.3 years (range 1.2-3.8) were identified. There were no significant differences between ANTA patients and DOBG patients in terms of age, previous treatment, stricture location, or postoperative follow-up. There was no significant difference between groups in the use of bilateral buccal grafts (P = .416); median buccal length harvested was significantly less in the ANTA group (4.5 cm [range 4.0-5.0]) vs the DOBG group (5.0 cm [range 5.0-8.0], P = .047). Response rate to the cross-sectional survey was 59%. Five patients reported postoperative donor site complications, and there were no significant differences between the ANTA and DOBG groups. Overall success was 93% and not statistically different between groups (log rank test, P = .548). One ANTA patient and 2 DOBG patients required posturethroplasty treatment. The ANTA has results similar to DOBG and appears to be a viable option in the treatment of bulbar urethral strictures. This technique allows the surgeon to avoid urethral transection, to reconfigure the width of the urethral plate, and to use a smaller buccal graft.

Long-term results of permanent urethral stent Memotherm implantation in the management of recurrent bulbar urethral stenosis

UNLABELLED What's known on the subject? and What does the study add? Milroy reported 84% success at a mean of 4.5 years follow-up by usage of a permanently implantable urolume spent in 1993. Memotherm was developed later, especially for urologic use. Our study is one of the largest in this urea, with a high number of patients and a long follow-up period. OBJECTIVE • To evaluate the effectiveness and long-term results of permanent urethral stent (Memotherm) implantation in the treatment of recurrent bulbar urethral stricture. PATIENTS AND METHODS • In all, 47 patients with a history of previous unsuccessful treatment for bulbar urethral stricture were treated using Memotherm bulbar urethral stents between 1998 and 2002. • Long-term follow-up data was analysed and discussed. RESULTS • At the end of the 7-year period 37 of 47 patients (78.7%) had been treated successfully. • Post-micturition dribbling incontinence lasting up to 3 months after stent placement occurred in 32 (68.1%) patients, but this was reduced to only seven patients (14.9%) by the 7-year follow-up. • There was stress incontinence of various severities in nine (19.2%) patients at the 1-year follow-up. These patients were those who had stenosed urethral segments adjacent to the external sphincter. At the long-term follow-up <10% of the patients had stress incontinence complaints. CONCLUSION • Memotherm is a good treatment option in patients with recurrent bulbar urethral stricture of any cause.

MP-12.15 Repeated Endoscopic Treatment of Bulbar Urethral Strictures is Associated With Increased Stricture Complexity and Duration of Symptoms

MP-12.15 Repeated Endoscopic Treatment of Bulbar Urethral Strictures is Associated With Increased Stricture Complexity and Duration of Symptoms

Long‐term results of permanent urethral stent Memotherm implantation in the management of recurrent bulbar urethral stenosis

What's known on the subject? and What does the study add? Milroy reported 84% success at a mean of 4.5 years follow-up by usage of a permanently implantable "urolume" spent in 1993. Memotherm was developed later, especially for urologic use. Our study is one of the largest in this urea, with a high number of patients and a long follow-up period. • To evaluate the effectiveness and long-term results of permanent urethral stent (Memotherm) implantation in the treatment of recurrent bulbar urethral stricture. • In all, 47 patients with a history of previous unsuccessful treatment for bulbar urethral stricture were treated using Memotherm bulbar urethral stents between 1998 and 2002. • Long-term follow-up data was analysed and discussed. • At the end of the 7-year period 37 of 47 patients (78.7%) had been treated successfully. • Post-micturition dribbling incontinence lasting up to 3 months after stent placement occurred in 32 (68.1%) patients, but this was reduced to only seven patients (14.9%) by the 7-year follow-up. • There was stress incontinence of various severities in nine (19.2%) patients at the 1-year follow-up. These patients were those who had stenosed urethral segments adjacent to the external sphincter. At the long-term follow-up <10% of the patients had stress incontinence complaints. • Memotherm is a good treatment option in patients with recurrent bulbar urethral stricture of any cause.

199 REPEATED ENDOSCOPIC TREATMENT OF BULBAR URETHRAL STRICTURES IS ASSOCIATED WITH INCREASED STRICTURE COMPLEXITY AND DURATION OF SYMPTOMS

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery1 Apr 2011199 REPEATED ENDOSCOPIC TREATMENT OF BULBAR URETHRAL STRICTURES IS ASSOCIATED WITH INCREASED STRICTURE COMPLEXITY AND DURATION OF SYMPTOMS Steven Hudak, Celeste Valadez, Timothy Atkinson, and Allen Morey Steven HudakSteven Hudak Dallas, TX More articles by this author , Celeste ValadezCeleste Valadez Dallas, TX More articles by this author , Timothy AtkinsonTimothy Atkinson Dallas, TX More articles by this author , and Allen MoreyAllen Morey Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.270AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Men presenting for urethroplasty often have a longstanding history of failed visual urethrotomy and/or urethral dilation procedures. Previous studies have suggested that prior endoscopic treatment for urethral strictures is associated with an increased urethroplasty failure rate. We sought to further explore the impact of previous endoscopic treatment on the clinical course of men with bulbar urethral strictures, including stricture complexity and duration of symptoms. METHODS A retrospective review of 340 consecutive urethroplasties performed by a single surgeon between July 2007 and October 2010 was performed. Patients were divided into two groups based on endoscopic treatment history for urethral stricture disease at the time of urethroplasty (group 1: 0–1 treatment; group 2: ≥2 treatments). Only those with bulbar strictures were included, thus excluding those with pure penile and membranous strictures, as well as patients with a history of prior urethroplasty, hypospadias, lichen sclerosis, and pelvic radiation. RESULTS During the 39 month study period, 140 men with bulbar urethral strictures met the study criteria: 50 had 0–1 previous endoscopic treatments (group 1), 51 had ≥2 previous endoscopic treatments (group 2), and 39 were excluded due to incomplete records. As shown in the table, repeated endoscopic treatment was strongly associated with longer strictures, more commonly extending into the penile urethra and less often amenable to anastomotic reconstruction. Repeated endoscopic treatment of bulbar urethral strictures was also associated with an 8-fold increase in the symptomatic interval between stricture diagnosis and urethroplasty. Influence of Prior Treatment on Bulbar Urethroplasty Outcome Group 1, n=50 Group2,n=51 p Symptomatic Interval 23months 187 months <0.001 Stricture length 2.29 cm 3.68 cm <0.001 Extension into penile urethra 2(4%) 12(24%) 0.005 Need for flap/graft 6(12%) 21(41%) <0.001 Synchronous strictures 2(4%) 5(10%) 0.436 Recurrence 1(2%) 6(12%) 0.110 CONCLUSIONS Repeated endoscopic treatment of bulbar strictures is associated with increased stricture complexity and a markedly prolonged duration of symptoms. These data suggest that repeated endoscopic intervention is counterproductive and should be discouraged in treatment of bulbar strictures. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e82-e83 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steven Hudak Dallas, TX More articles by this author Celeste Valadez Dallas, TX More articles by this author Timothy Atkinson Dallas, TX More articles by this author Allen Morey Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

200 SINGLE-STAGE TREATMENT OF DISTAL URETHRAL STRICTURES DUE TO BALANITIS XEROTICA OBLITERANS WITH CIRCULAR BUCCAL MUCOSA GRAFT

plasties performed by a single surgeon between July 2007 and October 2010 was performed. Patients were divided into two groups based on endoscopic treatment history for urethral stricture disease at the time of urethroplasty (group 1: 0–1 treatment; group 2: 2 treatments). Only those with bulbar strictures were included, thus excluding those with pure penile and membranous strictures, as well as patients with a history of prior urethroplasty, hypospadias, lichen sclerosis, and pelvic radiation. RESULTS: During the 39 month study period, 140 men with bulbar urethral strictures met the study criteria: 50 had 0–1 previous endoscopic treatments (group 1), 51 had 2 previous endoscopic treatments (group 2), and 39 were excluded due to incomplete records. As shown in the table, repeated endoscopic treatment was strongly associated with longer strictures, more commonly extending into the penile urethra and less often amenable to anastomotic reconstruction. Repeated endoscopic treatment of bulbar urethral strictures was also associated with an 8-fold increase in the symptomatic interval between stricture diagnosis and urethroplasty. CONCLUSIONS: Repeated endoscopic treatment of bulbar strictures is associated with increased stricture complexity and a markedly prolonged duration of symptoms. These data suggest that repeated endoscopic intervention is counterproductive and should be discouraged in treatment of bulbar strictures.

UP-1.168: Voiding and Erectile Functions after Anastomotic Urethroplasty

Anastomotic urethroplasty via the perineal approach is an excellent treatment for bulbar urethral strictures. We present postoperative voiding and erectile functions in 20 patients who underwent bulbar anastomotic urethroplasty in our institution.

Ventral Onlay Graft Urethroplasty Using Genital Skin or Buccal Mucosa in the Treatment of Bulbar Strictures: A Retrospective Analysis of 41 Cases

Background: The aim of this study was to evaluate the success of ventral onlay urethroplasty in the treatment of bulbar urethral strictures. Patients and Methods: The files of patients with bulbar stricture-disease treated with ventral onlay urethroplasty between January 2000 and July 2004 were retrospectively analysed. Forty-one patients with a mean age of 44.7 years (range 14–76 years) were included. Genital skin was used as a graft in 33 patients and buccal mucosa in 8 patients. The median follow-up was 3 years (range 1–5 years). If recurrence was suspected (clinical and/or on uroflowmetry), urethrography was performed. Need for any further instrumentation or re-operation was considered as a failure. Results: The mean stricture length was 5.2 cm (range 3–8 cm). Two complications (4.9%) were noted: 1 patient developed orchiepididymitis and another suffered from neuralgic pain in the region of the ischial nerve. Three patients (2 genital skins, 1 buccal mucosa) developed a recurrence of the stricture-disease. The final success rate was 92.7%. Conclusion: Ventral onlay urethroplasty remains a good technique in the treatment of bulbar urethral strictures that can not be treated with end-to-end anastomosis.

Augmented Anastomotic Urethroplasty

During substitution urethroplasty, if the stricture contains a 1 to 2 cm region that is particularly narrow and/or fibrotic, that portion may be excised with subsequent anastomosis of the dorsal or ventral aspect of the urethra to shorten, widen and optimize the urethral wall onto which an onlay graft is to be placed. This procedure is termed augmented anastomotic urethroplasty. To determine the effectiveness of this approach we reviewed our experience with augmented anastomotic urethroplasty in an 8-year period. We reviewed the records of patients who underwent augmented anastomotic urethroplasty between October 1997 and April 2005. Perioperative characteristics were compared between successes and failures using the Wilcoxon/Kruskal-Wallis and Fisher exact tests. Of 69 patients who underwent augmented anastomotic urethroplasty for recurrent urethral strictures 5 had undergone previous urethroplasty using a genital skin flap or graft. At a median followup of 34 months (range 13 to 103) 62 patients had no evidence of stricture recurrence and required no further intervention for an overall success rate of 90%. Stricture recurrence, defined as the inability to easily pass a standard flexible cystoscope through the area of repair, occurred in 7 patients (10%). Patients with stricture recurrence were significantly older (mean age 52 vs 39 years, p = 0.02) and more likely to experience postoperative urinary tract infection (28% vs 3.2%, p = 0.05) than patients without repeat stricture. Augmented anastomotic urethroplasty is an effective technique that allows the use of a shorter onlay graft. It may optimize overall results due to improvement in the urethral wall and the associated corpus spongiosum.