Skip to main content
SpringerLink
Log in

Treatment of Urethral Injury. II: The Anterior Urethra

  • Chapter
  • First Online:
Urogenital Trauma: A Practical Guide

  • 148 Accesses

Abstract

Alike the posterior urethral injury, SPC and delayed repair is preconized for anterior injury with severe contusion and hematoma. The rationale is to allow an incomplete injury to heal, then to assess the residual stricture after 3 months with combined antegrade and retrograde urethrography [1]. However, a greater room exists here for immediate urethral repair when several conditions are present, namely a complete, anterior, penetrating, or open injury, a stable patient, a minimal hematoma, an experienced surgeon, and non-involvement of other organs [1].

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Chapple C, Barbagli G, Jordan G, Mundy AR, Rodrigues-Netto N, Pansadoros V. Consensus statement on urethral trauma. BJU Int. 2004;93:1195–202.

    Article  CAS  PubMed  Google Scholar 

  2. Rourke KF, Jordan GH. Primary urethral reconstruction: the cost minimized approach to the bulbous urethral stricture. J Urol. 2005;173(4):1206–10. https://doi.org/10.1097/01.ju.0000154971.05286.81. PMID: 15758749.

    Article  PubMed  Google Scholar 

  3. Blaschko SD, Harris CR, Zaid UB, Gaither T, Chu C, Alwaal A, McAninch JW, McCulloch CE, Breyer BN. Trends, utilization, and immediate perioperative complications of urethroplasty in the United States: data from the national inpatient sample 2000-2010. Urology. 2015;85(5):1190–4. https://doi.org/10.1016/j.urology.2015.01.008. Epub 2015 Mar 4. PMID: 25746579; PMCID: PMC4917203.

    Article  PubMed  Google Scholar 

  4. Nilsen OJ, Holm HV, Ekerhult TO, Lindqvist K, Grabowska B, Persson B, Sairanen J. To transect or not transect: results from the Scandinavian urethroplasty study, a multicentre randomised study of bulbar urethroplasty comparing excision and primary anastomosis versus buccal mucosal grafting. Eur Urol. 2022;81(4):375–82. https://doi.org/10.1016/j.eururo.2021.12.017. Epub 2022 Jan 8. PMID: 35012771.

    Article  PubMed  Google Scholar 

  5. Bugeja S, Andrich DE, Mundy AR. Non-transecting bulbar urethroplasty. Transl Androl Urol. 2015;4(1):41–50. https://doi.org/10.3978/j.issn.2223-4683.2015.01.07. PMID: 26816808; PMCID: PMC4708276.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Barbagli G, Sansalone S, Djinovic R, Romano G, Lazzeri M. Current controversies in reconstructive surgery of the anterior urethra: a clinical overview. Int Braz J Urol. 2012;38(3):307–16; discussion 316. PMID: 22765862. https://doi.org/10.1590/s1677-55382012000300003.

    Article  PubMed  Google Scholar 

  7. Ozgök Y, Ozgür Tan M, Kilciler M, Tahmaz L, Erduran D. Use of bladder mucosal graft for urethral reconstruction. Int J Urol. 2000;7(10):355–60. https://doi.org/10.1046/j.1442-2042.2000.00210.x. PMID: 11144502.

    Article  PubMed  Google Scholar 

  8. Gelman J, Furr J. Tissue transfer techniques in the management of urethral stricture disease: flaps and grafts. In: Martins FE, Kulkarni SB, Köhler TS, editors. Textbook of male genitourethral reconstruction. Cham: Springer; 2020. https://doi.org/10.1007/978-3-030-21447-0_7.

    Chapter  Google Scholar 

  9. Filipas D, Wahlmann U, Hohenfellner R. History of oral mucosa. Eur Urol. 1998;34(3):165–8. https://doi.org/10.1159/000019705. PMID: 9732186.

    Article  CAS  PubMed  Google Scholar 

  10. Korneyev I, Ilyin D, Schultheiss D, Chapple C. The first oral mucosal graft urethroplasty was carried out in the 19th century: the pioneering experience of Kirill Sapezhko (1857-1928). Eur Urol. 2012;62(4):624–7. https://doi.org/10.1016/j.eururo.2012.06.035. Epub 2012 Jun 27. PMID: 22749735.

    Article  PubMed  Google Scholar 

  11. Humby G. A one-stage operation for hypospadias. Br J Surg. 1941;29:84–92.

    Article  Google Scholar 

  12. el-Kasaby AW, Fath-Alla M, Noweir AM, el-Halaby MR, Zakaria W, el-Beialy MH. The use of buccal mucosa patch graft in the management of anterior urethral strictures. J Urol. 1993;149(2):276–8. https://doi.org/10.1016/s0022-5347(17)36054-8. PMID: 8426400.

    Article  CAS  PubMed  Google Scholar 

  13. Morey AF, McAninch JW. When and how to use buccal mucosal grafts in adult bulbar urethroplasty. Urology. 1996;48(2):194–8. https://doi.org/10.1016/S0090-4295(96)00154-9. PMID: 8753728.

    Article  CAS  PubMed  Google Scholar 

  14. Barbagli G, Balò S, Sansalone S, Lazzeri M. How to harvest buccal mucosa from the cheek. Afr J Urol. 2016;22(1):18–23. https://doi.org/10.1016/j.afju.2015.09.001. issn:1110-5704.

    Article  Google Scholar 

  15. Barbagli G, Vallasciani S, Romano G, Fabbri F, Guazzoni G, Lazzeri M. Morbidity of oral mucosa graft harvesting from a single cheek. Eur Urol. 2010;58(1):33–41. https://doi.org/10.1016/j.eururo.2010.01.012. Epub 2010 Jan 19. PMID: 20106587.

    Article  PubMed  Google Scholar 

  16. Kulkarni SB, Barbagli G, Sansalone S, Joshi PM. Harvesting oral mucosa for one-stage anterior urethroplasty. Indian J Urol. 2014;30(1):117–21. https://doi.org/10.4103/0970-1591.124222. PMID: 24497698; PMCID: PMC3897044.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Monseur J. La reconstitution du canal de l’urètre au moyen des lames sus-urétérales et de la gouttière sous-caverneuse. J Urol Nephrol. 1968;74:755–7.

    CAS  Google Scholar 

  18. El-Kassaby A-W, Fath-Alla M, Maged W, Abdel-Aal A. Traitement des sténoses de l’urètre pénien par urétroplastie avec patch pédiculé dorsal : «Urétroplastie en toit». Prog Urol. 1998;8:1022–8.

    CAS  PubMed  Google Scholar 

  19. Aldaqadossi H, El Gamal S, El-Nadey M, El Gamal O, Radwan M, Gaber M. Dorsal onlay (Barbagli technique) versus dorsal inlay (Asopa technique) buccal mucosal graft urethroplasty for anterior urethral stricture: a prospective randomized study. Int J Urol. 2014;21(2):185–8. https://doi.org/10.1111/iju.12235. Epub 2013 Aug 12. PMID: 23931150.

    Article  PubMed  Google Scholar 

  20. Barbagli G, Palminteri E, Rizzo M. Dorsal onlay graft urethroplasty using penile skin or buccal mucosa in adult bulbourethral strictures. J Urol. 1998;160:1307–9.

    Article  CAS  PubMed  Google Scholar 

  21. Asopa HS, Garg M, Singhal GG, et al. Dorsal free graft urethroplasty for urethral stricture by ventral sagittal urethrotomy approach. Urology. 2001;58:657–9.

    Article  CAS  PubMed  Google Scholar 

  22. Horiguchi A. Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: current topics and reviews. Int J Urol. 2017;24(7):493–503. https://doi.org/10.1111/iju.13356. Epub 2017 Jun 10. PMID: 28600871.

    Article  PubMed  Google Scholar 

  23. Kulkarni S, Barbagli G, Sansalone S, Lazzeri M. One-sided anterior urethroplasty: a new dorsal onlay graft technique. BJU Int. 2009;104(8):1150–5. https://doi.org/10.1111/j.1464-410X.2009.08590.x. Epub 2009 Apr 17. PMID: 19388990.

    Article  PubMed  Google Scholar 

  24. Palminteri E, Berdondini E, Lumen N, Maruccia S, Florio M, Franco G, Montanaro V, Di Pierro GB. Kulkarni dorsolateral graft urethroplasty using penile skin. Urology. 2016;90:179–83. https://doi.org/10.1016/j.urology.2015.12.014. Epub 2015 Dec 29. PMID: 26743395.

    Article  PubMed  Google Scholar 

  25. Zumrutbas AE, Ozlulerden Y, Celen S, Kucuker K, Aybek Z. The outcomes of Kulkarni’s one-stage oral mucosa graft urethroplasty in patients with panurethral stricture: a single centre experience. World J Urol. 2020;38(1):175–81. https://doi.org/10.1007/s00345-019-02758-y. Epub 2019 Apr 8. PMID: 30963228.

    Article  CAS  PubMed  Google Scholar 

  26. Kulkarni S, Joshi P, Surana S, Hamouda A. Management of panurethral strictures. Afr J Urol. 2016;22(1):33–9. issn:1110-5704. https://doi.org/10.1016/j.afju.2016.01.001.

    Article  Google Scholar 

  27. Barbagli G, De Stefani S, Sighinolfi MC, Annino F, Micali S, Bianchi G. Bulbar urethroplasty with dorsal onlay buccal mucosal graft and fibrin glue. Eur Urol. 2006;50:467–74.

    Article  PubMed  Google Scholar 

  28. Barbagli G, Sansalone S, Kulkarni SB, Romano G, Lazzeri M. Dorsal onlay oral mucosal graft bulbar urethroplasty. BJU Int. 2012;109(11):1728–41. https://doi.org/10.1111/j.1464-410X.2012.11006.x. PMID: 22564323.

    Article  PubMed  Google Scholar 

  29. Palminteri E, Manzoni G, Berdondini E, Di Fiore F, Testa G, Poluzzi M, Molon A. Combined dorsal plus ventral double buccal mucosa graft in bulbar urethral reconstruction. Eur Urol. 2008;53(1):81–9. https://doi.org/10.1016/j.eururo.2007.05.033. Epub 2007 Jun 8. PMID: 17583417.

    Article  PubMed  Google Scholar 

  30. Waterloos M, Verla W. Female urethroplasty: a practical guide emphasizing diagnosis and surgical treatment of female urethral stricture disease. Biomed Res Int. 2019;2019:6715257.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Navarro-Galmes MA, Hernandez-Hernandez D, Padilla-Fernandez B, Castro-Diaz DM. Female urethroplasty: anterior vaginal wall flap (Blandy flap)—simpler tends to be better. Urol Int. 2022;106(3):313–6. https://doi.org/10.1159/000515994. Epub 2021 May 6. PMID: 33957637.

    Article  PubMed  Google Scholar 

  32. Orandi A. One-stage urethroplasty. Br J Urol. 1968;40(6):717–9. https://doi.org/10.1111/j.1464-410x.1968.tb11872.x. PMID: 4883846.

    Article  CAS  PubMed  Google Scholar 

  33. Maheshwari PN, Shah HN. Immediate endoscopic management of complete iatrogenic anterior urethral injuries: a case series with long-term results. BMC Urol. 2005;5:13. https://doi.org/10.1186/1471-2490-5-13.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Milroy EJ, Chapple CR, Cooper JE, Eldin A, Wallsten H, Seddon AM, Rowles PM. A new treatment for urethral strictures. Lancet. 1988;1(8600):1424–7. https://doi.org/10.1016/s0140-6736(88)92238-6. PMID: 2898583.

    Article  CAS  PubMed  Google Scholar 

  35. Badlani GH, Press SM, Defalco A, Oesterling JE, Smith AD. Urolume endourethral prosthesis for the treatment of urethral stricture disease: long-term results of the north American multicenter urolume trial. Urology. 1995;45(5):846–56. issn:0090-4295. https://doi.org/10.1016/S0090-4295(99)80093-4.

    Article  CAS  PubMed  Google Scholar 

  36. Wilson TS, Lemack GE, Dmochowski RR. Urolume stents: lessons learned. J Urol. 2002;167(6):2477–80. PMID: 11992061.

    Article  PubMed  Google Scholar 

  37. Frankiewicz M, Karolina M, Marcin M. Diagnosis and management of urolume urethral stent complications using ultrasonography and magnetic resonance imaging. Urology. 2020;144:e4–5. https://doi.org/10.1016/j.urology.2020.06.043. Epub 2020 Jul 7. PMID: 32650016.

    Article  PubMed  Google Scholar 

  38. Elliott SP, Coutinho K, Robertson KJ, D’Anna R, Chevli K, Carrier S, Aube-Peterkin M, Cantrill CH, Ehlert MJ, Te AE, Dann J, DeLong JM, Brandes SB, Hagedorn JC, Levin R, Schlaifer A, DeSouza E, DiMarco D, Erickson BA, Natale R, Husmann DA, Morey A, Olsson C, Virasoro R. One-year results for the ROBUST III randomized controlled trial evaluating the Optilume® drug-coated balloon for anterior urethral strictures. J Urol. 2022;207(4):866–75. https://doi.org/10.1097/JU.0000000000002346. Epub 2021 Dec 2. PMID: 34854748.

    Article  PubMed  Google Scholar 

  39. Pastorek D, Culenova M, Csobonyeiova M, Skuciova V, Danisovic L, Ziaran S. Tissue engineering of the urethra: from bench to bedside. Biomedicine. 2021;9(12):1917. https://doi.org/10.3390/biomedicines9121917. PMID: 34944733; PMCID: PMC8698949.

    Article  CAS  Google Scholar 

  40. Bhargava S, Chapple CR, Bullock AJ, Layton C, MacNeil S. Tissue-engineered buccal mucosa for substitution urethroplasty. BJU Int. 2004;93:807–11.

    Article  CAS  PubMed  Google Scholar 

  41. Bhargava S, Patterson JM, Inman RD, MacNeil S, Chapple CR. Tissue-engineered buccal mucosa urethroplasty-clinical outcomes. Eur Urol. 2008;53(6):1263–9. https://doi.org/10.1016/j.eururo.2008.01.061. Epub 2008 Feb 4. PMID: 18262717.

    Article  PubMed  Google Scholar 

  42. Ram-Liebig G, Barbagli G, Heidenreich A, Fahlenkamp D, Romano G, Rebmann U, Standhaft D, van Ahlen H, Schakaki S, Balsmeyer U, Spiegler M, Knispel H. Results of use of tissue-engineered autologous oral mucosa graft for urethral reconstruction: a multicenter, prospective, observational trial. EBioMedicine. 2017;23:185–92. https://doi.org/10.1016/j.ebiom.2017.08.014. Epub 2017 Aug 16. PMID: 28827035; PMCID: PMC5605371.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, The Royal Hospital, Muscat, Oman

    Said Abdallah AL-Mamari

Authors
  1. Said Abdallah AL-Mamari
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

AL-Mamari, S.A. (2023). Treatment of Urethral Injury. II: The Anterior Urethra. In: Urogenital Trauma: A Practical Guide. Springer, Singapore. https://doi.org/10.1007/978-981-99-6171-9_32

Download citation

  • DOI: https://doi.org/10.1007/978-981-99-6171-9_32

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-99-6170-2

  • Online ISBN: 978-981-99-6171-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation