Outcomes of transecting urethroplasty in management of different types of bulbar urethral strictures: single center experience

Ayman Moussa Atwa; Ayman Ahmed Hassan; Samir Shabaan Orabi; Samir Abdelhakim Elgamal; Osama Mostafa Elgamal

doi:10.18203/2349-2902.isj20213270

Authors

Ayman Moussa Atwa Department of Urology, Tanta Faculty of Medicine, Egypt
Ayman Ahmed Hassan Department of Urology, Tanta Faculty of Medicine, Egypt
Samir Shabaan Orabi Department of Urology, Alexandria Faculty of Medicine, Egypt
Samir Abdelhakim Elgamal Department of Urology, Tanta Faculty of Medicine, Egypt
Osama Mostafa Elgamal Department of Urology, Tanta Faculty of Medicine, Egypt

DOI:

https://doi.org/10.18203/2349-2902.isj20213270

Keywords:

Urethra, Stricture, Urethroplasty, Urethrogram

Abstract

Background: The study aimed to evaluate the outcomes of transecting bulbar urethroplasty techniques used for management of bulbar urethral stricture as regards the success rate and sexual dysfunction.

Methods: Our study was a prospective study and it was carried out at urology department Tanta university, Egypt. The study was approved our ethical committee and an informed consent was obtained from all participants. Thirty patients underwent transecting urethroplasty either excision and primary anastomosis (EPA) or augmented anastomotic urethroplasty. Assessment of the sexual function by sexual health inventory for men (SHIM) questionnaire and postoperatively. Retrograde urethrogram (RGU) and micturating cystourethrogram (MCUG) were performed by an experienced urological surgeon.

Results: The age of studied patients ranged from 15-72 years with a mean of 41±13.87. The length of stricture ranged from 2-3 cm with a mean of 2.57±0.38. The stricture was non obliterative in 13 patients (43.3%), obliterative in 4 patients (13.3%) and near obliterative in 13 patients (43.3%). Anastomotic urethroplasty was carried out in 20 out of 30 patients (66.7%) and augmented anastomotic urethroplasty was carried out in 10 out of 30 patients (33.3%). The success rate was 90%. As regard erectile dysfunction, 5 patients reported erectile dysfunction (16.7%).

Conclusions: Anastomotic urethroplasty of short segment bulbar strictures continues to have excellent success rates and durability, but some patients who undergo anastomotic urethroplasty experience de novo sexual dysfunction.

Metrics

Metrics Loading ...

References

Jordan GH, McCammon KA. Surgery of the Penis and Urethra. Campbell-Walsh Urology. 11th ed. Philadelphia: Elsevier; 2012: 956-1000.

Peterson AC, Webster GD. Management of urethral stricture disease: developing options for surgical intervention. BJU Int. 2004;94(7):971-6.

Eltahawy EA, Virasoro R, Schlossberg SM, McCammon KA, Jordan GH. Long-term followup for excision and primary anastomosis for anterior urethral strictures. J Urol. 2007;177(5):1803-6.

Meeks JJ, Erickson BA, Granieri MA, Gonzalez CM. Stricture recurrence after urethroplasty: a systematic review. J Urol. 2009;182(4):1266-70.

Andrich DE, Mundy AR. Non-transecting anastomotic bulbar urethroplasty: a preliminary report. BJU Int. 2012;109(7):1090-4.

Morey AF, Kizer WS. Proximal bulbar urethroplasty via extended anastomotic approach-what are the limits? J Urol. 2006;175(6):2145-9.

Barbagli G, DeAngelis M, Romano G, Lazzeri M. Long-term follow up of bulbar end-to-end anastomosis: a retrospective analysis of 153 patients in a single center experience. J Urol. 2007;178(6):2470-3.

Barbagli G, Sansalone S, Romano G, Lazzeri M. Bulbar urethroplasty. Curr Opin Urol. 2012;22(6):474-7.

Barbagli G, Lazzeri M. Reconstructive urethral surgery to be addressed at 2009 GURS meeting. Int Braz J Urol. 2009;14:14.

Bertrand LA, Voelzke BB, Elliott SP, et al. Measuring and predicting patient dissatisfaction after anterior urethroplasty using patient reported outcomes measures. J Urol. 2016;196(2):453.

Maciejewski CC, Haines T, Rourke KF. Chordee and penile shortening rather than voiding function are associated with patient dissatisfaction after urethroplasty. Urology 2017; 103: 234.

Mundy AR, Andrich DE. Urethral strictures. BJU Int. 2011;107(1):6-26.

Chapman DW, Cotter K, Johnsen NV, Patel S, Kinnaird A, Erickson BA, et al. No transecting techniques reduce sexual dysfunction after anastomotic bulbar urethroplasty: results of a multi-institutional comparative analysis. J Urol. 2019;201(2):364-70.

Welk BK, Kodama RT. The augmented nontransected anastomotic urethroplasty for the treatment of bulbar urethral strictures. Urology. 2012;79(4):917-21.

Lumen N, Spiers S, Backer SD, Pieters R, Oosterlinck W. Assessment of the short-term functional outcome after urethroplasty: a prospective analysis. Int Braz J Urol. 2011;37(6):712-8.

Beysens M, Palminteri E, Oosterlinck W, Spinoit AF, Hoebeke P, François P, et al. Anastomotic repair versus free graft urethroplasty for bulbar strictures: a focus on the impact on sexual function. Adv Urol. 2015;2015:912438.

Ekerhult TO, Lindqvist K, Peeker R, Grenabo L. Low risk of sexual dysfunction after transection and nontransection urethroplasty for bulbar urethral stricture. J Urol. 2013;190(2):635-8.

Corriere JN, Rudy DC, Benson GS. Voiding and erectile function after delayed one-stage repair of posterior urethral disruptions in 50 men with a fractured pelvis. J Trauma. 1994;37:587-9.

Johnson EK, Latini JM. The impact of urethroplasty on voiding symptoms and sexual function. Urology. 2011;78(1):198-201.

Yucel S, Baskin LS: Neuroanatomy of the male urethra and perineum. BJU Int. 2003;92(6):624-30.

Yucel S, Baskin LS. Identification of communicating branches among the dorsal, perineal and cavernous nerves of the penis. J Urol. 2003;170(1):153-8.

Dogra PN, Singh P, Nayyar R, Yadav S. Sexual dysfunction after urethroplasty. Urol Clin North Am. 2017;44(1):49-56.

Mundy AR. Results and complications of urethroplasty and its future. Br J Urol. 1993;71(3):322-5.

Coursey JW, Morey AF, McAninch JW, Summerton DJ, Secrest C, White P, et al. Erectile function after anterior urethroplasty. J Urol. 2001;166(6):2273-6.

Erickson BA, Granieri MA, Meeks JJ, Cashy JP, Gonzalez CM. Prospective analysis of erectile dysfunction after anterior urethroplasty: incidence and recovery of function. J Urol. 2010;183(2):657-61.