NON-TRANSECTING ANASTOMOTIC BULBAR URETHROPLASTY FOR URETHRAL STRICTURE DISEASE-EXPERIENCE FROM A HIGH-VOLUME SPECIALIST CENTRE

Authors

  • Imran Memon Assistant Professor of Urology Department of Urology, Liaquat University of Medical & Health Sciences, Jamshoro. Ex- Registrar, Liaquat National Medical College & Hospital Karachi.
  • Kashifuddin Qayoom Soomro Clinical Assistant Professor, Department Of Urology,Liaquat University of Medical & Health Sciences Jamshoro, Sindh
  • Zakir Hussain Rajpar Clinical Assistant Professor, Department Of Urology,Liaquat University of Medical & Health Sciences Jamshoro, Sindh Ex Resident Medical Officcer, Liaquat National Hopsital Karachi
  • Aziz Abdullah Head & Professor of Urology, Department of Urology, Liaquat NAtional Medical College & Hospital Karachi.

Abstract

Background:  Urethral stricture disease has significant economic impact throughout world. The bulbar urethra is the commonest site for urethral strictures (Approx 50%) followed by penile urethra in most of the published literature.In developing countries trauma (road traffic accident and iatrogenic) is the leading cause of urethral stricture disease.Younger patients have usually idiopathic type as compare to old age group, which present more frequently with iatrogenic and trauma related urethral strictures. Methods: This Qausi Experimental study was conducted from May2012-June2016 of duration at Liaquat National Hospital Karachi. All the patients diagnosed with short urethral strictures related to bulbar urethra were included in this study. All the patients underwent non transecting bulbar urethroplasty. All patients were assessed preoperatively, peri-operatively and postoperatively and on follow-up visits as; on 2nd, 8th and 24th week. All the data regarding outcome was recorded on the Performa and analyzed on SPSS V20. Results: Total of 179patients were included, mean age was 38±SD15.3years (range 20–65years). Anatomically bulbar urethra was affected in 52% of the cases followed by bulbopenile, bulbomembranous region. Etiologically idiopathic type was found in 40% cases, while trauma 21%, iatrogenic injury 26% and UTI 13% were also reasons. Stricture length was mean1.1±SD 1.4 cm (range 0.5–2.5cm). Preoperative Uroflowmetry revealed mean Qmax of 10.5±SD 5.3 ml/sec. Mean operative time was 35±SD 4.6 minutes, 7 patients had conversion to other procedures (3.91%), Postoperative complications were minimal. Mean follow up was 12±SD 21 months (range 6 months to 3 years). On initial follow up at 8th week and 24th week, Qmax was significantly improved. Only 3 patients required DVIU after the 24th week. Initial success rate after 24th week was 98.3% and eventually 100% at the long-term follow-up. Conclusion: non-transecting anastomotic bulbar urethroplasty (NTABU) is a new standard of care for the short bulbar urethral stricture up to 2.5cm. Idiopathic aetiology, iatrogenic and posttraumatic urethral strictures in selective patients can safely be operated with this technique.Keyword: Non-transecting; bulbar Urethroplasty; Urethral strictures

References

Santucci RA, Joyce GF, Wise M. Male urethral stricture disease. J Urol 2007;177(5):1667–74.

Palminteri E, Berdondini E, Verze P, De Nunzio C, Vitarelli A, Carmignani L. Contemporary urethral stricture characteristics in the developed world. Urology 2013;81(1):191–6.

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(3):983–7.

Hussain M, Askari H, Lal M, Naqvi SA, Rizvi SA. Experience at a stricture clinic in a developing country. J Pak Med Assoc 2013;63(2):234–8.

Mundy AR, Andrich DE. Urethral strictures. BJU Int 2011;107(1):6–26.

Latini JM, McAninch JW, Brandes SB, Chung JY, Rosenstein D. SIU/ICUD consultation on urethral strictures: Epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral disruption injuries. Urology 2014;83(3 Suppl):S1–7.

Jhanwar A, Kumar M, Sankhwar SN, Prakash G. Holmium laser vs. conventional (cold knife) direct visual internal urethrotomy for short-segment bulbar urethral stricture: Outcome analysis. Can Urol Assoc J 2016;10(5-6):E161–4.

Pal DK, Kumar S, Ghosh B. Direct visual internal urethrotomy: Is it a durable treatment option? Urol Ann 2017;9(1):18–22.

Cooperberg MR, McAninch JW, Alsikafi NF, Elliott SP. Urethral reconstruction for traumatic posterior urethral disruption: outcomes of a 25-year experience. J Urol 2007;178(5):2006–10.

Andrich DE, Dunglison N, Greenwell TJ, Mundy AR. The long-term results of urethroplasty. J Urol 2003;170(1):90–2.

Kluth LA, Dahlem R, Reiss P, Pfalzgraf D, Becker A, Engel O, et al. Short-term outcome and morbidity of different contemporary urethroplasty techniques-a preliminary comparison. J Endourol 2013;27(7):925–9.

Levine LA, Strom KH, Lux MM. Buccal mucosa graft urethroplasty for anterior urethral stricture repair: evaluation of the impact of stricture location and lichen sclerosus on surgical outcome. J Urol 2007;178(5):2011–5.

Andrich DE, Mundy AR. Non-transecting anastomotic bulbar urethroplasty: a preliminary report. BJU Int 2011;109(7):1090–4.

Bugeja S, Andrich DE, Mundy AR. Non-transecting bulbar Urethroplasty. Transl Androl Urol 2015;4(1):41–50.

Bugeja S, Ivaz S, Frost AV, Andrich DE, Mundy AR. Non-transecting bulbar urethroplasty using buccal mucosa. Afr J Urol 2016;22(1):47–53.

Ahmad H, Mahmood A, Niaz WA, Akmal M, Murtaza B, Nadim A. Bulbar urethral stricture repair with buccal mucosa graft urethroplasty. J Pak Med Assoc 2011;61(5):440–2.

Blaschko SD, Harris CR, Zaid UB, Gaither T, Chu C, Alwaal A, et al. 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.

Heyns CF, Marais DC. Prospective evaluation of the American Urological Association symptom index and peak urinary flow rate for the followup of men with known urethral stricture disease. J Urol 2002;168(5):2051–4.

Erickson BA, Breyer BN, McAninch JW. Changes in uroflowmetry maximum flow rates after urethral reconstructive surgery as a means to predict for stricture recurrence. J Urol 2011;186(5):1934–7.

Ekerhult TO, Lindqvist K, Peeker R, Grenabo L. Low risk of sexual dysfunction after transection and nontransection urethroplasty for bulbar urethral stricture. J Urol 2013;190(2):635–8.

Downloads

Published

2020-02-18