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Summary

Abstract

Introduction

Protocol

Representative Results

Discussion

Acknowledgements

Materials

References

Medicine

Vessel-sparing Excision and Primary Anastomosis

Published: January 7th, 2019

DOI:

10.3791/58214

1Department of Urology, Ghent University Hospital

Here, we present an elaborate and efficient protocol to treat isolated short bulbar or posterior urethral strictures with vessel-sparing excision and primary anastomosis.

Urethroplasty is considered to be the standard treatment for urethral strictures since it provides excellent long-term success rates. For isolated short bulbar or posterior urethral strictures, urethroplasty by excision and primary anastomosis (EPA) is recommended. As EPA only requires the excision of the narrowed segment and the surrounding spongiofibrosis, a full-thickness transection of the corpus spongiosum, as performed in the traditional transecting EPA (tEPA), is usually unnecessary. Jordan et al. introduced the idea of a vessel-sparing approach in 2007, aiming to reduce surgical trauma, especially to the dual arterial blood supply of the urethra, and, thus, potentially reducing the risk of postoperative erectile dysfunction or glans ischemia. This approach could also be beneficial for subsequent urethral interventions such as redo urethroplasty using a free graft, in which a well-vascularized graft bed is imperative. Nevertheless, these potential benefits are only assumptions as prospective studies comparing the functional outcome of both techniques with validated questionnaires are currently lacking. Moreover, vessel-sparing EPA (vsEPA) should at least be able to provide similar surgical outcomes as tEPA. The aim of this paper is to give an elaborate, step-by-step overview of how to manage patients with isolated short bulbar or posterior urethral strictures with vsEPA. The main objective of this manuscript is to outline the surgical technique and to report the representative surgical outcome. A total of 117 patients were managed according to the described protocol. The analysis was performed on the entire patient cohort and on the bulbar (n = 91) and posterior (n = 26) vsEPA group separately. Success rates were 93.4% and 88.5% for the bulbar and posterior vsEPA, respectively. To conclude, vsEPA, as outlined in the protocol, provides excellent success rates with low complication rates for isolated short bulbar and posterior urethral strictures.

Urethroplasty is considered the standard treatment for urethral strictures as it provides excellent long-term success rates1,2. A numerous amount of surgical techniques has been described, challenging the reconstructive urologist to choose the best approach, considering various stricture modalities such as the number of strictures, the stricture length, the stricture location, the etiology, comorbidities, and previous urethral interventions. For isolated short bulbar urethral strictures, the International Consultation on Urologic Diseases (ICUD) recommends urethroplasty by excision and primary anastomosis (EPA....

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All patients provided a signed written informed consent and the approval of the local Ethics Committee (EC/2014/0438) was obtained.

NOTE: The inclusion criteria for the presented protocol were: male; age ≥18 years; signed written informed consent; fit for operation; isolated urethral stricture; urethral stricture ≤3 cm; urethral stricture only at the bulbar or membranous site. The exclusion criteria were: female; transgender; age <18 years; absence of signed wr.......

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Between 2011 and 2017, a total of 117 patients with isolated short bulbar (n = 91) or posterior (n = 26) urethral strictures were treated with vsEPA at Ghent University Hospital. The baseline characteristics are displayed in Table 1. The median follow-up was 35 and 45 months for bulbar and posterior strictures, respectively. The strictures were longer in the patients who underwent posterior vsEPA and, accordingly, the number of patients with a calculated.......

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Urethral stricture repair by vessel-sparing excision and primary anastomosis was initially performed at Ghent University Hospital in 2010. Thereafter, it became a standard of practice in the hospital's management of patients with isolated short bulbar or posterior urethral strictures. As the bulb remains attached to the perineal body, access to the posterior urethra and the resection of the fibrotic tissue at that site can be compromised. A distortion of the pubic rami due to a pelvic fracture might further impede ac.......

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The authors have no acknowledgments.

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Name Company Catalog Number Comments
iso-Betadine Dermicum 125 ml (1) Meda Pharma A-472825
Sterile gown (3) According to surgeon's preference NA
Sterile gloves (3 pairs) According to surgeon's preference NA
Sterile drapes (4) Medline AGBBA073A
Bard-Parker scalpel number 3 (1) Zepf Medical Instruments 06-1003-00
Bard-Parker scalpel number 4 (1) KLS Martin Group 10-100-04
Scalpel blade number 15 (1) Swann-Morton 0205
Scalpel blade number 24 (1) Swann-Morton 0211
Surgical forceps 14 cm (2) KLS Martin Group 12-301-14
Monopolar electrocauter Valleylab  (1) Medtronic E2100
Electrocauter blade 15 cm (1) Comepa CO 150i
Debakey forceps 20 cm (2) Düfner 06232-20
3-layered compress 30 x 45 cm (5) Mölnlycke Health Care 175260
Surgical compress 10 x 10 cm (10) Hartmann 232088
Mayo-Hegar needle driver 18 cm (1) Zepf Medical Instruments 24-1804-18
Mayo-Hegar needle driver 25 cm (1) Zepf Medical Instruments 24-1804-25
Jones scissor 18 cm (1) Düfner 04940-18
Mayo-Stille scissor 17 cm (1) Zepf Medical Instruments 08-1700-17
Lone Star retractor (1) CooperSurgical, Trumbull, CT, USA 72403867
Lone Star elastic stays (4) CooperSurgical, Trumbull, CT, USA 3311-1G
Vessel loop 45 cm (1) Braun 1095137
Halsted-Mosquito (6) KLS Martin Group 13-317-21
20Fr silicone urethral catheter (1) Yushin Medical Co. 1037B-20
3Fr ureteral catheter (1) Teleflex 223602
20Fr metal sound (1) Custom made NA
Vicryl 4-0 wire (6) Ethicon V734D
Vicryl 3-0 wire (2) Ethicon VCP316H
Vicryl Rapide 3-0  wire (1) Ethicon VF2260
10Fr Drain needle (1) Vygon 658.10
10Fr Suction drain (1) Oriplast 203102
Vacuum flask 400 ml (1) Oriplast 213215AL/QL
Zetuvit 10 x 20 cm (1) Hartmann 413771

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