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


Authors: G. H. Jordan;  U. Gur
Authors‘ workplace: Department of Urology, Eastern Virginia Medical School, Norfolk, Virginia
Published in: Urol List 2009; 7(4): 50-54

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


Sources

1. Mundy AR. The long-term results of skin inlay urethroplasty. Br J Urol 1995; 75(1): 59–61.

2. Eltahawy EA, Virasoro R, Schlossberg SM et al. Long-term follow-up for excision and primary anastomosis for anterior urethral strictures. J Urol 2007; 177(5): 1803–1806.

3. Morey AF, Kizer WS. Proximal bulbar urethroplasty via extended anastomotic approach-what are the limits? J Urol 2006; 175(6):2145–2149; discussion 2149

4. Gur U, Jordan GH: Vessel-sparing excision and primary anastomosis (for proximal bulbar urethral strictures). BJU Int 2008; 101(9): 1183–1195.

Labels
Paediatric urologist Urology

Article was published in

Urological Journal

Issue 4

2009 Issue 4

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