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Dorsal approach for double-face bulbar urethroplasty: ventral inlay plus dorsal onlay using Kulkarni one-side dissection

  • Urology - Original Paper
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Abstract

Background

Non-traumatic obliterative bulbar urethral stricture with residual urethral lumen below 3 Fr is a challenging surgical scenario for reconstructive surgeons, because either anastomotic or single augmentation urethroplasty is not an option.

Objectives

To describe our double-face buccal mucosa graft (BMG) urethroplasty with dorsal onlay and ventral inlay relying on the vessels and nerve-sparing technique of Kulkarni’s one-side dissection.

Methods

We retrospectively reviewed a prospectively maintained database of patients with non-traumatic obliterative bulbar urethral strictures who underwent double-face bulbar urethroplasty with one-side dissection and dorsal onlay plus ventral inlay BMG. Patient demographics, clinical data, and follow-up were analyzed.

Results

A total of 59 patients underwent double-face urethroplasty with dorsal approach. The median age was 37 years (IQR 27–49) and the median stricture length was 5 cm (IQR 3.75–6). No patients had immediate post-operative complications. The overall success rate was 88% with a median follow-up of 30.9 months (IQR 16.9–44.2). Two patients were treated with DVIU, and two patients with open urethral surgery. One patient developed erectile dysfunction after surgery. Age, etiology, stenosis length and previous treatment were not factors related to surgical failure.

Conclusion

Our preliminary albeit encouraging results showed that this approach was feasible in all patients and with negligible perioperative complications. Success rate was 88%. We did not find any factors related to surgical failure. Our dorsal double-face augmented urethroplasty may be a valid alternative to the Palminteri’s ventral double-face urethroplasty, especially in those patients with mid-distal bulbar or peno-bulbar urethral strictures.

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Authors and Affiliations

  1. Kulkarni Reconstructive Urology Center, Pune, India

    Cristina Ballesteros Ruiz, Marco Bandini, Pankaj M. Joshi, Sandeep Bafna, Vipin Sharma, Shreeranga L. Yatam, Shreyas Bhadranavar, Amey Patil & Sanjay B. Kulkarni

  2. Hospital Universitario la Paz, Madrid, Spain

    Cristina Ballesteros Ruiz

  3. Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy

    Marco Bandini

  4. Centro Chirurgico Toscano, Arezzo, Italy

    Marco Bandini

Authors
  1. Cristina Ballesteros Ruiz
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  2. Marco Bandini
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  3. Pankaj M. Joshi
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  4. Sandeep Bafna
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  5. Vipin Sharma
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  6. Shreeranga L. Yatam
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  7. Shreyas Bhadranavar
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  8. Amey Patil
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  9. Sanjay B. Kulkarni
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Contributions

CBR: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. MB: protocol/project development, data analysis, and manuscript writing/editing. PMJ protocol/project development and manuscript writing/editing. SB: data collection or management. VS: data collection or management. SLY: data collection or management. SB: data collection or management. AP: data collection or management. SBK: protocol/project development and manuscript writing/editing.

Corresponding author

Correspondence to Cristina Ballesteros Ruiz.

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There are no conflicts of interest.

Ethical approval

A retrospective analysis was performed using patient information (history, surgery and evolution).

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Patients gave their informed consent to use their data for research purposes.

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Ballesteros Ruiz, C., Bandini, M., Joshi, P.M. et al. Dorsal approach for double-face bulbar urethroplasty: ventral inlay plus dorsal onlay using Kulkarni one-side dissection. Int Urol Nephrol 54, 1039–1045 (2022). https://doi.org/10.1007/s11255-022-03158-9

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  • DOI: https://doi.org/10.1007/s11255-022-03158-9

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