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Reconstruction of Membranous Urethral Strictures

  • Javier C. Angulo
  • Reynaldo G. Gómez
  • Dmitriy Nikolavsky
Surgery (J Simhan, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Surgery

Abstract

Purpose of Review

Due to the proximity of the rhabdosphincter and cavernous nerves to the membranous urethra, reconstruction of membranous urethral stricture implies a risk of urinary incontinence and erectile dysfunction. To avoid these complications, endoscopic management of membranous urethral strictures is traditionally favored, and bulboprostatic anastomosis is reserved as the main classical approach for open reconstruction of recalcitrant membranous urethral stricture. The preference for the anastomotic urethroplasty among reconstructive urologists is likely influenced by the familiarity and experience with trauma-related injuries. We review the literature focusing on the anatomy of membranous urethra and on the evolution of treatments for membranous urethral strictures.

Recent Findings

Non-traumatic strictures affecting bulbomembranous urethra are typically sequelae of instrumentation, transurethral resection of the prostate, prostate cancer treatment, and pelvic irradiation. Being a different entity from trauma-related injuries where urethra is not in continuity, a new understanding of membranous urethral anatomy is necessary for the development of novel reconstruction techniques. Although efficacious and durable to achieve urethral patency, classical bulboprostatic anastomosis carries a risk of de-novo incontinence and impotence. Newer and relatively less invasive reconstructive alternatives include bulbar vessel-sparing intra-sphincteric bulboprostatic anastomosis and buccal mucosa graft augmented membranous urethroplasty techniques. The accumulated experience with these techniques is relatively scarce, but several published series present promising results. These approaches are especially indicated in patients with previous transurethral resection of the prostate in which sparing of rhabdosphincter and the cavernous nerves is important in attempt to preserve continence and potency. Additionally, introduction of buccal mucosa onlay grafts could be especially beneficial in radiation-induced strictures to avoid transection of the sphincter in continent patients, and to preserve the blood supply to the urethra for incontinent patients who will require artificial urinary sphincter placement. The evidence regarding erectile functional outcomes is less solid and this item should be furtherly investigated.

Keywords

Urethral stricture Membranous urethra Urinary incontinence Erection Surgical technique Mouth mucosa 

Notes

Acknowledgements

The authors acknowledge José María Gil Vernet for the illustration of Professor Salvador Gil Vernet and also José Domínguez for photographic assistance.

Compliance with Ethical Standards

Conflict of Interest

Javier C. Angulo and Dmitriy Nikolavsky each declare no potential conflicts of interest.

Reynaldo G. Gómez is an advisor and mentor for Boston Scientific and speaker for Eli-Lilly.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Javier C. Angulo
    • 1
  • Reynaldo G. Gómez
    • 2
  • Dmitriy Nikolavsky
    • 3
  1. 1.Departamento Clínico, Facultad de Ciencias Biomédicas, Hospital Universitario de GetafeUniversidad Europea de MadridGetafeSpain
  2. 2.Hospital del TrabajadorUniversidad Andrés BelloSantiagoChile
  3. 3.Department of UrologySUNY Upstate Medical UniversitySyracuseUSA

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