Skip to main content
SpringerLink
Log in

Non-transecting dorsal mucosal anastomosis plus ventral oral graft for the treatment of urethral bulbar strictures: single surgeon experience

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

To report our experience with the non-transecting dorsal mucosal anastomosis plus ventral oral graft urethroplasty (NTAVOG) for the repair of tight bulbar urethral strictures.

Methods

Data of 68 men with tight bulbar strictures underwent NTAVOG urethroplasty between 2012 and 2019 were retrospectively revised. The urethra was opened ventrally; the dorsal scarred mucosa was excised preserving the spongiosum; the mobilized mucosal edges were anastomosed to recreate the dorsal urethral plate; the repaired urethral plate was augmented by the ventral oral graft and the spongiosum was closed over it. Successful urethral reconstruction was defined as normal voiding without the need for any postoperative procedure. Sexual function was investigated using a validated questionnaire.

Results

Median follow-up was 58 months (IQR 38–63) and mean stricture length was 1 cm (IQR 1–1.5). Of 68 cases, 56 (82.4%) were successful and 12 (17.6%) were failures requiring re-treatment. At multivariable analysis, no preoperative factor was significantly associated with recurrence. None of the preoperatively sexually active 53 patients reported postoperative erectile impairment and all were satisfied with their sexual life. The main limitation is the retrospective design.

Conclusions

In cases of tight bulbar stricture, the NTAVOG urethroplasty provides adequate urethral augmentation by preserving the spongiosum and avoiding postoperative sexual complications.

Patient summary

We presented a series of patients undergone non-transecting dorsal anastomosis plus ventral oral graft urethroplasty for tight bulbar stricture. This treatment seems to be safe and with limited postoperative complications thanks to the preservation of the corpus spongiosum.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Andrich DE, Mundy AR (2008) What is the best technique for urethroplasty? Eur Urol 54:1031

    Article  PubMed  Google Scholar 

  2. Patterson JM, Chapple CR (2008) Surgical techniques in substitution urethroplasty using buccal mucosa for the treatment of anterior urethral strictures. Eur Urol 53:1162

    Article  PubMed  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. Morey AF, Kizer WS (2006) Proximal bulbar urethroplasty via extended anastomotic approach—what are the limits? J Urol 175:2145

    Article  PubMed  Google Scholar 

  5. Elliott SP, Metro MJ, McAninch JW (2003) Long-term follow up of the ventrally placed buccal mucosa onlay graft in bulbar urethral reconstruction. J Urol 169:1754

    Article  PubMed  Google Scholar 

  6. Barbagli G, Montirsi F, Guazzoni G, Larcher A, Fossati N, Sinsalone S, Romano G, Buffi N, Lizzeri M (2013) Ventral oral mucosal onlay graft urethroplasty in nontraumatic bulbar urethral strictures: surgical technique and multivariable analysis of results in 214 patients. Eur Urol 64:440

    Article  PubMed  Google Scholar 

  7. Palminteri E, Manzoni G, Berdondini E et al (2008) Combined dorsal plus ventral double buccal mucosa graft in bulbar urethral reconstruction. Eur Urol 53:81

    Article  PubMed  Google Scholar 

  8. Andrich DE, Mundy AR (2011) Non-transecting anastomotic bulbar urethroplasty: a preliminary report. BJU Int 109:1090

    Article  PubMed  Google Scholar 

  9. Welk B, Kodama R (2012) The augmented non-transected anastomotic urethroplasty for the treatment of bulbar urethral strictures. Urology 79:917

    Article  PubMed  Google Scholar 

  10. Coursey JW, Morey AF, McAninch JW et al (2001) Erectile function after anterior urethroplasty. J Urol 166:2273

    Article  CAS  PubMed  Google Scholar 

  11. Anderson KM, Blakely SA, O’Donnell CI, Nikolavsky D, Flynn BJ (2017) Primary non-transecting bulbar urethroplasty long-term success rates are similar to transecting urethroplasty. Int Urol Nephrol 49(1):83

    Article  PubMed  Google Scholar 

  12. Virasoro R, De Long JM (2020) Non-transecting bulbar urethroplasty is favored over transecting techniques. World J Urol 38(12):3013

    Article  PubMed  Google Scholar 

  13. Barbagli G, De Angelis M, Romano G et al (2007) Long-term follow up of bulbar end-to-end anastomosis a retrospective analysis of 153 patients in a single center experience. J Urol 178:2470

    Article  PubMed  Google Scholar 

  14. Kessler T, Fish M, Heitz M et al (2002) Patient satisfaction with the outcome of surgery for urethral strictures. J Urol 167:2507

    Article  PubMed  Google Scholar 

  15. Al-Qudah HS, Santucci RA (2006) Buccal mucosal onlay urethroplasty versus anastomotic urethroplasty (AU) for short urethral strictures: which is better? J Urol 175(suppl):103

    Article  Google Scholar 

  16. Palminteri E, Berdondini E, Shokeir AA, Iannotta L, Gentile V, Sciarra A (2011) Two-sided bulbar urethroplasty using dorsal plus ventral oral graft: urinary and sexual outcomes of a new technique. J Urol 185(5):1766

    Article  PubMed  Google Scholar 

  17. Welk B, Kodama R (2012) Outcomes of the augmented non-transected anastomotic (ANTA) urethroplasty for the treatment of bulbar urethral strictures. Urology 79:917

    Article  PubMed  Google Scholar 

  18. Barbagli G, Vallasciani S, Romano G et al (2010) Morbidity of oral mucosa graft harvesting from a single cheek. Eur Urol 58:33

    Article  PubMed  Google Scholar 

  19. Barbagli G, Sinsilone S, Djinovic R, Romano G, Lizzeri M (2012) Current controversies in reconstructive surgery of the anterior urethra: a clinical overview. Int Braz J Urol 38(3):307

    Article  PubMed  Google Scholar 

  20. Morán E, Sáez Moreno I, Bonillo MA, Dagá O, Martínez-Cuenca E, Arlandis S, Broseta E (2021) Ventral approach for the non-transecting bulbar urethroplasty. Urology 152:197

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Urethral Reconstructive Surgery, Humanitas University, Via Leoni 6, 52100, Arezzo, Italy

    Enzo Palminteri, Mirko Preto & Nicolò Lenci

  2. Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy

    Andrea Mari

  3. Department of Urology, Hesperia Hospital, CURE Group, Modena, Italy

    Daniele Vitelli & Luca Cindolo

  4. U.O. Urologia Ospedale San Carlo di Nancy Roma-GVM Care and Research, Dip. di Chirurgia Università di Roma Tor Vergata, Rome, Italy

    Valerio Iacovelli & Pierluigi Bove

  5. Urology Department, Humanitas Research Hospital, Rozzano, Italy

    Nicolò Buffi

Authors
  1. Enzo Palminteri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mirko Preto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Mari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicolò Lenci
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniele Vitelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Valerio Iacovelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pierluigi Bove
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nicolò Buffi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Luca Cindolo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Protocol/project development: EP and LC. Data collection or management: EP, MP, NL, NB, PB, and DV. Data analysis: EP, MP, AM, NL, NB, and PB. Manuscript writing/editing: EP, AM, LC, and VI.

Corresponding author

Correspondence to Luca Cindolo.

Ethics declarations

Conflict of interest

None.

Research involving human participants and/or animals

The present study was conducted in accordance with the Standards of Good Clinical Practice and the Declaration of Helsinki.

Informed consent

All patients signed a dedicated written informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Palminteri, E., Preto, M., Mari, A. et al. Non-transecting dorsal mucosal anastomosis plus ventral oral graft for the treatment of urethral bulbar strictures: single surgeon experience. Int Urol Nephrol 54, 3171–3177 (2022). https://doi.org/10.1007/s11255-022-03257-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-022-03257-7

Keywords

Search

Navigation