Vessel sparing technique for proximal anterior urethral stricture disease: primary anastomosis and augmented anastomosis

Overview

Presented is a technique for proximal bulbous or bulbomembranous urethral reconstruction. It represents a modification of previously employed techniques. This technique has the potential advantage of preservation of the proximal urethral blood supply (arteries to the bulb).

Materials and Method:
From June 2003 and February 2009, 20 number of patients underwent vessel spa­ring urethral reconstruction via the technique of excision and primary anastomosis, vessel sparing augmen­ted anastomosis using a vessel sparing technique, and reconstruction for pelvic fracture urethral distraction defect using a vessel sparing technique. Described herein is the technique employed in these patients.

Results:
Patient age ranged from 3 years of age to 82 years of age, mean age 45. In that, the numbers reported are small, with regards to efficacy, we have had no failures to date. However, that statement implies only that these techniques are equivalent to standard techniques, given relatively short follow-up.

Conclusion:
It would seem that preservation of blood supply in any situation of reconstruction would be be­ne­ficial. As such, we were led to explore this technique. We first applied the technique in patients who have had radical prostatectomy, had very proximal bulbomembranous strictures and in whom it was felt that possibly implantation of an AMS800 artificial urethral sphincter might be required. At present, it is estimated that patients have about a 12% lifetime risk of developing prostate cancer, and so many pa­tients may be opera­ted on for strictures that then later will require radical prostatectomy and later may require implantation of a sphincter for incontinence. However, our initial studies suggest equivalence and we have now expanded the application of this technique to any patient whose stricture appears to be amenable. Certainly further analysis is warranted to evaluate the efficacy and advantages of this modification.

Key words:
anterior urethra, urethral reconstruction, urethral stricture, penile vessels