Double-face urethroplasty in patients with obliterative bulbar strictures post-transurethral resection of the prostate mid-term outcomes in high-volume referral center

doi:10.1016/j.ajur.2021.11.001

Asian Journal of Urology, 2023, 10 (4): 512-517 doi: 10.1016/j.ajur.2021.11.001

Original Articles

Double-face urethroplasty in patients with obliterative bulbar strictures post-transurethral resection of the prostate mid-term outcomes in high-volume referral center

Pankaj M. Joshi^a,Manuel Hevia^b,*(

),Yatam Lakshmi Sreeranga^a,Marco Bandini^c,Amey Patil^a,Shreyas Bhadranavar^a,Vipin Sharma^a,Sandeep Bafna^a,Sanjay B. Kulkarni^a

^aKulkarni Reconstructive Urology Center, 3, Rajpath Society, Paud Road, Pune 411038, India
^bUrology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
^cUrological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita Salute, San Raffaele University, Milan, MI, Italy

Abstract
Related Citation (8)

Download:

HTML

PDF (19028KB)
Export: BibTeX | EndNote (RIS)

Abstract

Objective: Incidences of post-transurethral resection of the prostate (post-TURP) strictures are between 2.2% and 9.8%. Stricture commonly occurs within the first 6 months. Our objective was to assess the outcomes of patients with obliterative strictures post-TURP that underwent a double-face urethroplasty.

Methods: This is a single-center prospective study of 17 patients with obliterative proximal bulbar stricture post-TURP who underwent double-face graft urethroplasty by two surgeons between January 2014 and January 2020. We defined post-TURP obliterative strictures as those patients who presented with complete or almost complete obstruction of the urethral lumen and who have had a history of acute urine retention. We have excluded patients with bladder neck contracture. Primary outcome was treatment success, defined as the no need for further treatments. Secondary outcome was post-urethroplasty continent rate.

Results: Seventeen patients were included in the study with median age of 66 (interquartile range 40-77) years; median time of follow-up was 24 (interquartile range 12-84) months; median stricture length was 4 (interquartile range 2-6) cm. Of the 17 patients, 15 (88.2%) were successful. All patients were continent after urethroplasty.

Conclusion: With mid-term follow-up, treatment of obliterative proximal bulbar strictures with double-face buccal mucosa graft is a safe and effective procedure. Obliterative proximal bulbar strictures merit double-face urethroplasty with high-rate success and functional outcomes.

Key words： Double-face urethroplasty Obliterative urethral stricture Post-transurethral resection of prostate Urethral stricture Spongiofibrosis Iatrogenic stricture

Received: 08 April 2021 Available online: 20 October 2023

Corresponding Authors: *E-mail address: manuel.hevia.palacios@gmail.com (M. Hevia).

	Service
	E-mail this article
	Add to citation manager
	E-mail Alert
	Articles by authors
	Pankaj M. Joshi
	Manuel Hevia
	Yatam Lakshmi Sreeranga
	Marco Bandini
	Amey Patil
	Shreyas Bhadranavar
	Vipin Sharma
	Sandeep Bafna
	Sanjay B. Kulkarni

TRENDMD:

Cite this article:

Pankaj M. Joshi,Manuel Hevia,Yatam Lakshmi Sreeranga, et al. Double-face urethroplasty in patients with obliterative bulbar strictures post-transurethral resection of the prostate mid-term outcomes in high-volume referral center[J]. Asian Journal of Urology, 2023, 10(4): 512-517.

URL:

http://www.ajurology.com/EN/10.1016/j.ajur.2021.11.001 OR http://www.ajurology.com/EN/Y2023/V10/I4/512

Endoscopic view of proximal bulbar obliterative stricture. (A) Retrograde endoscopy of bulbar urethral stricture with minimum passage (<3 mm); (B) Endoscopy of complete obliterative bulbar urethral stricture.

Urethrogram of obliterative stricture at bulbar urethra post-transurethral resection of the prostate.

Urethral dissection and ventral approach. (A) The 3 Fr guide-wire and methylene blue were inserted through the urethra; (B) Bulbospongiosus muscle was incised in midline; (C and D) The urethra was incised ventrally over a dilator and the urethrotomy was continued proximally and distally; (E and F) The urethra was incised and a stay suture was taken from the urethra, through the spongy tissue, very close to the mucosa and held apart; (G) The urethrotomy was extended till good pink urethral mucosa was seen; (H) Proximal part of the graft was sutured on its ventral face.

Dorsal graft. (A and B) A nasal speculum passed through the urethra and a dorsal inlay incision made across the obliterated urethral plate; (C) Buccal mucosa graft placed as dorsal inlay; (D) The graft fixed using AbsorbaTack? (Absorbatack 710, Medtronic Parkway, Minneapolis, MN, USA).

Ventral graft and urethral closure. (A) The ventral graft sutured with two running sutures; (B) Spongy tissue sutured to cover the graft.

Patient characteristics.

Treatment of patients with recurrent urethral stricture.

[1]	Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol 2010; 58:384-97. doi: 10.1016/j.eururo.2010.06.005 pmid: 20825758
[2]	Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)dincidence, management, and prevention. Eur Urol 2006; 50:969-79. doi: 10.1016/j.eururo.2005.12.042 pmid: 16469429
[3]	Kulkarni SB, Joglekar O, Alkandari M, Joshi PM. Management of post TURP strictures. World J Urol 2019; 37:589-94. doi: 10.1007/s00345-018-2498-x pmid: 30267196
[4]	Fenton AS, Morey AF, Aviles R, Garcia CR. Anterior urethral strictures: etiology and characteristics. Urology 2005; 65: 1055-8. doi: 10.1016/j.urology.2004.12.018 pmid: 15913734
[5]	Komura K, Inamoto T, Takai T, Uchimoto T, Saito K, Tanda N, et al. Incidence of urethral stricture after bipolar transurethral resection of the prostate using TURis: results from a randomised trial. BJU Int 2015; 115:644-52. doi: 10.1111/bju.12831 pmid: 24909399
[6]	Gómez RG, Velarde LG, Campos RA, Saavedra AA, Delgado EJ, Santucci RA, et al. Intrasphincteric anastomotic urethroplasty allows preservation of continence in men with bulbomembranous urethral strictures following benign prostatic hyperplasia surgery. World J Urol 2020; 39:2099-106. doi: 10.1007/s00345-020-03399-2
[7]	Lumen N, Hoebeke P, Willemsen P, De Troyer B, Pieters R, Oosterlinck W. Etiology of urethral stricture disease in the 21st century. J Urol 2009; 182:983-7. doi: 10.1016/j.juro.2009.05.023 pmid: 19616805
[8]	Barbagli G, Kulkarni SB, Joshi PM, Nikolavsky D, Montorsi F, Sansalone S, et al. Repair of sphincter urethral strictures preserving urinary continence: surgical technique and outcomes. World J Urol 2019; 37:2473-9. doi: 10.1007/s00345-019-02686-x pmid: 30798381
[9]	Oelrich TM. The urethral sphincter muscle in the male. Am J Anat 1980; 158:229-46. doi: 10.1002/aja.v158:2
[10]	Mundy AR. The treatment of sphincter strictures. Br J Urol 1989; 64:626-8. pmid: 2627637
[11]	Angulo JC, Gómez RG, Nikolavsky D. Reconstruction of membranous urethral strictures. Curr Urol Rep 2018; 19:37. https://doi.org/10.1007/s11934-018-0786-z. doi: 10.1007/s11934-018-0786-z pmid: 29644478
[12]	Andrich DE, Mundy AR. What is the best technique for urethroplasty? Eur Urol 2008; 54:1031-41. doi: 10.1016/j.eururo.2008.07.052 pmid: 18715692
[13]	Palminteri E, Lumen N, Berdondini E, Di Pierro GB, Cucchiarale G, Tenti G, et al. Two-sided dorsal plus ventral oral graft bulbar urethroplasty: long-term results and predictive factors. Urology 2015; 85:942-7.
[14]	Palminteri E, Berdondini E, Shokeir AA, Iannotta L, Gentile V, Sciarra A. Two-sided bulbar urethroplasty using dorsal plus ventral oral graft: urinary and sexual outcomes of a new technique. J Urol 2011; 185:1766-71. doi: 10.1016/j.juro.2010.12.103 pmid: 21420128
[15]	Palminteri E, Manzoni G, Berdondini E, Di Fiore F, Testa G, Poluzzi M, et al. Combined dorsal plus ventral double buccal mucosa graft in bulbar urethral reconstruction. Eur Urol 2008; 53:81-9. doi: 10.1016/j.eururo.2007.05.033 pmid: 17583417
[16]	Dalpiaz O, Mitterberger M, Kerschbaumer A, Pinggera GM, Bartsch G, Strasser H. Anatomical approach for surgery of the male posterior urethra. BJU Int 2008; 102:1448-51. doi: 10.1111/j.1464-410X.2008.07772.x pmid: 18540937
[17]	Asopa HS, Garg M, Singhal GG, Singh L, Asopa J, Nischal A. Dorsal free graft urethroplasty for urethral stricture by ventral sagittal urethrotomy approach. Urology 2001; 58:657-9. pmid: 11711331
[18]	Joshi PM, Raveenthiran S, Desai DJ, Kulkarni J, Kulkarni SB. Vicryl tack for graft fixation during bulbar urethroplasty. Trends 2019; 10:26-8.
[19]	Strasser H, Bartsch G. Anatomy and innervation of the rhabdosphincter of the male urethra. Semin Urol Oncol 2000; 18: 2-8. pmid: 10719924
[20]	Hollabaugh RS, Dmochowski RR, Steiner MS. Neuroanatomy of the male rhabdosphincter. Urology 1997; 49:426-34. pmid: 9123709
[21]	Strasser H, Klima G, Poisel S, Horninger W, Bartsch G. Anatomy and innervation of the rhabdosphincter of the male urethra. Prostate 1996; 28:24-31. pmid: 8545278
[22]	Blakely S, Caza T, Landas S, Nikolavsky D. Dorsal onlay urethroplasty for membranous urethral strictures: urinary and erectile functional outcomes. J Urol 2016; 195:1501-7. doi: S0022-5347(15)05246-5 pmid: 26602890
[23]	Favre GA, Alfieri AG, Gil Villa SA, Tobia I, Giudice CR. Bulbomembranous urethral strictures repair after surgical treatment of benign prostatic hyperplasia. Experience from a Latin American Referral Centre. Urology 2021; 147:281-6. doi: 10.1016/j.urology.2020.08.085 pmid: 33098863
[24]	Morey AF, McAninch JW. When and how to use buccal mucosal grafts in adult bulbar urethroplasty. Urology 1996; 48:194-8. pmid: 8753728
[25]	Gimbernat H, Arance I, Redondo C, Meilán E, Andrés G, Angulo JC. Treatment for long bulbar urethral strictures with membranous involvement using urethroplasty with oral mucosa graft. Actas Urol Esp 2014;38:544-51.