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82597

Augmented Anastomotic Urethroplasty for Long Segment Bulbous Urethral Strictures

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Last updated: 22 Jan 2023

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Abstract

Background: During urethroplasty, if the stricture contains a 2 to 4 cm region that is particularly narrow and/or fibrotic, anastomotic repair is not ideal, so that portion may be excised with subsequent anastomosis of the 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 Objectives: Evaluation of the outcome of augmented anastomotic urethroplasty with dorsal onlay for long segment bulbar urethral stricture. Patients and Methods: A prospective clinical trial was carried out during the period from March 2017 to September 2019 of 55 patients underwent dorsal onlay augmented anastomosis using buccal mucosa graft for long segment bulbar urethral strictures. All patients underwent pre-operative medical history taking and physical examination, sono-urethrography and voiding cystourethrogram. Patients were followed-up and re-assessed at 3 and 6 months post-operatively. Follow-up urethrography was performed at 6 months. The primary outcome was the procedure success rate defined by the successful voiding function. Stricture recurrence was defined the presence of intractable voiding symptoms or the need for any urethral interventions. The data were analyzed using the appropriate statistical tests. Results: During the study period, 55 patients completed the follow-up protocol and included in the study. The mean age was 41.93±10.70 years. The mean intra-operative stricture length was 3.39±0.59 cm. Buccal mucosal graft was used in all cases. Mean graft length was 4.15±0.62 cm. At 6 months follow up, 51 patients had no evidence of stricture recurrence and required no further intervention with an overall success rate of 92.7%. Stricture recurrence occurred in 4 patients (7.3%). No donor site major complications were detected. The urethroplasty complication rate was 20.0%, and all were minor. No effect of urethroplasty on erectile function in adult sexually active patients. No penile shortening or chordee. Conclusions: Dorsal onlay augmented anastomosis was a useful technique for long bulbar strictures. High stricture-free rates and complications are few and minor. Although longer follow up was needed.

DOI

10.21608/amj.2020.82597

Keywords

Reconstructive surgery, stricture, Urethral reconstruction, bulbar

Authors

First Name

Mohamed

Last Name

Al-Gammal

MiddleName

Ibrahim

Affiliation

Department of Urology, Al-Azhar Faculty of Medicine, Cairo, Egypt

Email

gemykarter2020@gmail.com

City

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Orcid

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First Name

Abdullah

Last Name

Abdullah

MiddleName

Mohamed

Affiliation

Department of Urology, Al-Azhar Faculty of Medicine, Cairo, Egypt

Email

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City

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Orcid

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First Name

Abul-Fotouh

Last Name

Abul-Fotouh

MiddleName

Abd El-Maguid

Affiliation

Department of Urology, Al-Azhar Faculty of Medicine, Cairo, Egypt

Email

-

City

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Orcid

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First Name

Gamal

Last Name

Selmy

MiddleName

Ibrahim

Affiliation

Department of Urology, Al-Azhar Faculty of Medicine, Cairo, Egypt

Email

-

City

-

Orcid

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Volume

49

Article Issue

2

Related Issue

10133

Issue Date

2020-04-01

Receive Date

2020-04-15

Publish Date

2020-04-01

Page Start

825

Page End

838

Print ISSN

1110-0400

Link

https://amj.journals.ekb.eg/article_82597.html

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https://amj.journals.ekb.eg/service?article_code=82597

Order

44

Type

Original Article

Type Code

941

Publication Type

Journal

Publication Title

Al-Azhar Medical Journal

Publication Link

https://amj.journals.ekb.eg/

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Article

Created At

22 Jan 2023