A Novel Approach to Short Bulbar Urethral Strictures: Ventral Urethrotomy for a Non-Transection Excision and Primary Anastomosis
Introduction: 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. The previously described technique involves a dorsal urethrotomy and excision of the stricture without disrupting the anterior spongiosum. We describe a novel approach by performing a ventral urethrotomy leaving the posterior spongiosum intact. By not requiring urethral rotation, we believe this technique is simpler and does not compromise outcomes. Methods: Retrospective chart review was performed on 8 consecutive patients from April 2019 to February 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. Results: All 8 patients underwent the aforementioned procedure. Average age was 48.6 years, and average stricture length was 1.375 cm. All 8 patients underwent postoperative voiding cystourethrogram at 2 weeks which confirmed no contrast extravasation and no residual stricture. We had a stricture free rate of 100% (8/8 cases) with median follow-up time of 4 months (range 0-14 months). Average increase in Q-max was 14.2 mL/s. Conclusion: 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 with the added benefit of requiring less complexity
Geisenhoff A, Kraemer S, Burks F. A novel approach to short bulbar urethral strictures: ventral urethrotomy for a non-transecting excision and primary anastomosis. Paper presented at: The 95th Annual Meeting of the North Central Section of the AUA; 2021 Oct 6-9; Chicago, IL. Available at: https://ncsaua.org/docs/meetings/ncs2110/ncs-2021-program-book.aspx
The 95th Annual Meeting of the North Central Section of the AUA, Chicago, IL, October 6-9, 2021.