A Novel Approach to Short Bulbar Urethral Strictures: Ventral Urethrotomy for a Non-Transecting Excision and Primary Anastomosis

Document Type

Conference Proceeding

Publication Date

5-2024

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVE: Excision and primary anastomosis (EPA) has been the gold standard procedure for definitively managing short bulbar urethral strictures. A non-transecting approach was developed to help preserve proximal blood supply of the urethra, and described as a “vessel sparing” technique. The previously described technique involves a dorsal urethrotomy without disrupting the anterior spongiosum or the blood vessels supplying the bulb. This requires significant and delicate mobilization of the urethra and bulbar arteries. We describe a novel approach by performing a ventral urethrotomy leaving the posterior spongiosum, and thus its blood supply intact. METHODS: A retrospective chart review was performed on 11consecutive patients from April 2019 to July 2021 who underwent non-transecting EPA with ventral urethrotomy for short bulbar urethral strictures. We reviewed demographics and when available pre and postoperative data points including uroflow, post-void residuals, SHIM and AUA scores. Our approach begins with standard midline perineal dissection carried through the bulbospongiosus muscle. Ventral urethrotomy is performed traversing the strictured segment followed by excision of the strictured dorsal mucosa from within the urethra, leaving the posterior spongiousum intact. The excised segment of the dorsal wall of the urethra is then reapproximated with circumferential interrupted 5-0 polydixone sutures. A Foley catheter is placed across the anastamosis, and a second layer of suture is used to reapproximate the anterior spongiousum in a Heineke-Mikulicz fashion. RESULTS: All 11 patients underwent the aforementioned non-transecting EPA. Average age was 44.3 years, and average stricture length was 1.32 cm. All 11 patients underwent postoperative VCUG at 2 weeks which confirmed no contrast extravasation or residual stricture. Our stricture free rate was 100% (11/11 cases) with median follow-up time of 5 months (range 0.5-14 months). Average increase in peak flow rate was 14.1 mL/s and average postoperative PVR was15.8 mL. CONCLUSIONS: Our case series demonstrates that non-transecting EPA with ventral urethrotomy is a safe and effective alternative to dorsal urethrotomy for the management of short bulbar urethral strictures. It also has the added benefit of requiring less surgical complexity and preservation of dorsal urethral blood supply from the posterior corpus spongiosum.

Volume

211

Issue

5S

First Page

e521

Comments

American Urological Association Annual Meeting, May 3-6, 2024, San Antonio, TX

DOI

10.1097/01.JU.0001008816.80828.35.16

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