Augmented Non-transecting bulbar urethroplasty
BAUS ePoster online library. Frost A. 06/24/19; 259525; P4-10
Dr. Anastasia Frost
Dr. Anastasia Frost
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Abstract
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Introduction

We developed the augmented non-transecting anastomotic urethroplasty procedure(ANTABU) for selected long non-traumatic bulbar strictures with an obliterative segment component as an alternative to simply augmenting the entire stricture.

Patients and Methods

Between 2012-2017, 45 patients underwent ANTABU. Follow-up was clinically, using PROMs, flow rate and urethrography. Mean follow-up was 14.8months(12-38.2months). Surgical technique involves excision of spongiofibrosis in the tightest segment of a longer bulbar stricture in a non-transecting fashion with the rest of the dorsal stricturotomy augmented with a buccal graft.

RESULTS

37(82.2%) strictures were idiopathic, 2(4.4%)post-TURP, 6(13.4%)catheter-related. Mean stricture length was 5.4 cm(3 – 9cm). Mean length of obliterative spongiofibrosis excised in a non-transecting fashion was 1.2cm(0.5 – 2cm). Graft was harvested from the cheek in 37(82%)patients and sublingually in 8(18%).

2 of 43(5%)patients had radiological evidence of recurrence. Mean flow rate at least 1 year postoperatively was 25.4ml/s. 28 of 32patients(87.5%) reported they were satisfied/very satisfied with the surgical outcome. 1 patient could not void due to detrusor failure. 13(29%) patients developed post-micturition dribble which was tolerable in all. Erectile dysfunction longer than 6 months was reported in 1 patient(2%).

CONCLUSION

ANTABU allows excision of the narrowest segment of spongiofiibrosis without disrupting the integrity of ventral spongiosal blood flow, reconstituting the urethral plate to a wider calibre, avoiding an almost circumferential substitution in this area. This also permits the use of narrower and shorter oral grafts with reduced donor site morbidity. We have demonstrated excellent results with this technique in the short to intermediate term.
Introduction

We developed the augmented non-transecting anastomotic urethroplasty procedure(ANTABU) for selected long non-traumatic bulbar strictures with an obliterative segment component as an alternative to simply augmenting the entire stricture.

Patients and Methods

Between 2012-2017, 45 patients underwent ANTABU. Follow-up was clinically, using PROMs, flow rate and urethrography. Mean follow-up was 14.8months(12-38.2months). Surgical technique involves excision of spongiofibrosis in the tightest segment of a longer bulbar stricture in a non-transecting fashion with the rest of the dorsal stricturotomy augmented with a buccal graft.

RESULTS

37(82.2%) strictures were idiopathic, 2(4.4%)post-TURP, 6(13.4%)catheter-related. Mean stricture length was 5.4 cm(3 – 9cm). Mean length of obliterative spongiofibrosis excised in a non-transecting fashion was 1.2cm(0.5 – 2cm). Graft was harvested from the cheek in 37(82%)patients and sublingually in 8(18%).

2 of 43(5%)patients had radiological evidence of recurrence. Mean flow rate at least 1 year postoperatively was 25.4ml/s. 28 of 32patients(87.5%) reported they were satisfied/very satisfied with the surgical outcome. 1 patient could not void due to detrusor failure. 13(29%) patients developed post-micturition dribble which was tolerable in all. Erectile dysfunction longer than 6 months was reported in 1 patient(2%).

CONCLUSION

ANTABU allows excision of the narrowest segment of spongiofiibrosis without disrupting the integrity of ventral spongiosal blood flow, reconstituting the urethral plate to a wider calibre, avoiding an almost circumferential substitution in this area. This also permits the use of narrower and shorter oral grafts with reduced donor site morbidity. We have demonstrated excellent results with this technique in the short to intermediate term.

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