Abstract
Purpose
The published literature shows controversies with regard to the treatment of choice for longer stricture. Augmented anastomotic urethroplasty (AAU) was described for long bulbar urethral strictures with an extended area of narrowing and fibrosis, the technique combines the advantages of both anastomosis and graft substitution. We aimed to compare the dorsal and ventral strip anastomosis in the AAU.
Methods
A retrospective Review was conducted at the Department of Urology, Sohag University Hospital; we included adult patients with long bulbar urethral strictures (> 2 cm) who underwent dorsal or ventral strip AAU. Patients were followed at 1, 3, 6, and 12 months postoperatively for subjective improvements. The statistical analysis was carried with SPSS software version 24 for windows.
Results
At the end of follow-up, stricture recurrence occurred in 5 (12.5%) in ventral strip group compared to 6 (23.1%) in dorsal group, the difference was not statistically significant (p = 0.5). With regard to safety outcomes, there was no statistically significant difference between both groups in any of the postoperative complications, except post-void dribbling which showed higher incidence in dorsal strip group (p < 0.001).
Conclusions
In conclusion, both dorsal strip and ventral strip techniques are feasible for long bulbar urethral strictures with comparable postoperative efficacy outcomes and high success rate.
Similar content being viewed by others
References
Santucci RA, Joyce GF, Wise M (2007) Male urethral stricture disease. J Urol 177:1667–1674. https://doi.org/10.1016/j.juro.2007.01.041
Mundy AR, Andrich DE (2011) Urethral strictures. BJU Int 107:6–26. https://doi.org/10.1111/j.1464-410X.2010.09800.x
Palminteri E, Berdondini E, Verze P et al (2013) Contemporary urethral stricture characteristics in the developed world. Urology 81:191–196. https://doi.org/10.1016/j.urology.2012.08.062
Lumen N, Hoebeke P, Willemsen P et al (2009) Etiology of urethral stricture disease in the 21st Century. J Urol 182:983–987. https://doi.org/10.1016/j.juro.2009.05.023
Hampson LA, McAninch JW, Breyer BN (2014) Male urethral strictures and their management. Nat Rev Urol 11:43–50. https://doi.org/10.1038/nrurol.2013.275
Pansadoro V, Emiliozzi P (1996) Internal urethrotomy in the management of anterior urethral strictures: long-term followup. J Urol 156:73–75. https://doi.org/10.1016/S0022-5347(01)65942-1
Morey AF, Kizer WS (2006) Proximal bulbar urethroplasty via extended anastomotic approach-what are the limits? J Urol 175:2145–2149. https://doi.org/10.1016/S0022-5347(06)00259-X
Bhargava S, Chapple CR (2004) Buccal mucosal urethroplasty: is it the new gold standard? BJU Int 93:1191–1193. https://doi.org/10.1111/j.1464-410X.2003.04860.x
Barbagli G, Selli C, di Cello V, Mottola a (1996) A one-stage dorsal free-graft urethroplasty for bulbar urethral strictures. Br J Urol 78:929–932
Guralnick ML, Webster GD (2001) The augmented anastomotic urethroplasty: indications and outcome in 29 patients. J Urol 165:1496–1501
Abouassaly R, Angermeier KW (2007) Augmented anastomotic urethroplasty. J Urol 177:2211–2216. https://doi.org/10.1016/j.juro.2007.01.140
El-Kassaby AW, El-Zayat TM, Azazy S, Osman T (2008) One-stage repair of long bulbar urethral strictures using augmented Russell dorsal strip anastomosis: outcome of 234 cases. Eur Urol 53:420–424. https://doi.org/10.1016/j.eururo.2007.06.002
Lee YJ, Kim SW (2013) Current management of urethral stricture. Korean J Urol 54:561–569. https://doi.org/10.4111/kju.2013.54.9.561
Mangera A, Patterson JM, Chapple CR (2011) A systematic review of graft augmentation urethroplasty techniques for the treatment of anterior urethral strictures. Eur Urol 59:797–814. https://doi.org/10.1016/j.eururo.2011.02.010
Andrich DE, Leach CJ, Mundy AR (2001) The Barbagli procedure gives the best results for patch urethroplasty of the bulbar urethra. BJU Int 88:385–389. https://doi.org/10.1046/j.1464-410X.2001.02344.x
Patterson JM, Chapple CR (2008) Surgical techniques in substitution urethroplasty using buccal mucosa for the treatment of anterior urethral strictures. Eur Urol 53:1162–1171. https://doi.org/10.1016/j.eururo.2007.10.011
Radopoulos D, Tzakas C, Dimitriadis G et al (2007) Dorsal on-lay preputial graft urethroplasty for anterior urethra strictures repair. Int Urol Nephrol 39:497–503. https://doi.org/10.1007/s11255-006-9029-1
Acimovic M, Milojevic B, Milosavljevic M et al (2016) Primary dorsal buccal mucosa graft urethroplasty for anterior urethral strictures in patients with lichen sclerosus. Int Urol Nephrol 48:541–545. https://doi.org/10.1007/s11255-015-1202-y
Barbagli G, Selli C, Tosto A, Palminteri E (1996) Dorsal free graft urethroplasty. J Urol 155:123–126. https://doi.org/10.1016/S0022-5347(01)66566-2
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
The study was conducted in accordance with the International Conference on Harmonization Good Clinical Practice guidelines, the Declaration of Helsinki, and applicable local regulatory requirements and laws, the study was approved by the institutional review board of the Sohag University Hospital.
Rights and permissions
About this article
Cite this article
Reyad, A.M., Mamdouh, A., Rashed, E. et al. Dorsal versus ventral strip augmented anastomotic bulbar urethroplasty: retrospective study. Int Urol Nephrol 50, 1257–1261 (2018). https://doi.org/10.1007/s11255-018-1899-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-018-1899-5