Mini-invasive reconstruction technique of the bulbomembranous urethra

Abstract

The paper presents the technique of the reconstruction of the bulbar and membranous urethra in the occurrence of strictures and sphincter-stenosis. The method uses an autologous graft and has potential advantages over the bulboprostatic anastomosis. Objective. To develop a method of helping patients with existing urethral anastomoses, with a damaged neck of the bladder and a risk of subsequent incontinence, wishing to maintain the erectile function. Materials and methods. 35 patients underwent 36 reconstructions of the urethra from August 2013 to July 2017, 11-after previous urethral plastics, 14-after prostate surgery (4-after radical prostatectomy), 7-suffered from a urethral distraction defect. The age of the patients was 58.17 ± 12.2 years. The median follow-up period was 525 (341; 813) days. The average length of urethral strictures was 15 (10; 15) mm. The average diameter of the urethra in the stricture zone was 1.4 ± 0.56 mm. Reconstruction with the use of a buccal mucosa graft is performed intraurethrally through corpus spongiosum using magnifying optics. Results. The overall efficacy of the primary reconstruction in 35 patients was 94.2 %; the repeated reconstruction in two patients was successful. All patients underwent the comprehensive monitoring of the results, the average follow-up period was 654 days, the average relapse-free period was 447 days. All patients preserved continence and erectile function Conclusion. The proposed technique showed a high efficiency in reconstruction of the bulbar and membranous urethra.

Fast Track Surgery as the Latest Multimodal Strategy of Enhanced Recovery after Urethroplasty

“…The final choice of the method of surgical treatment was made in advance and corrected intraoperatively. The main types of operations were anastomotic urethroplasty (EPA) in the form of the classic Turner-Warwick/Webster operation [ 17 , 18 ], vascular-sparing methods [ 19 ], intraurethral anastomosis [ 20 ], and buccal mucosa graft urethroplasty using various techniques (Asopa [ 21 ], Barbagli [ 22 ] and others), as well as the original minimally invasive technique [ 23 ].…”

Buccal mucosal graft urethroplasty of the bulbomembranous part of urethra

“…Plastic surgeries were performed by the method of urethral anastomosis after excision of the affected area (EPA) or by the developed method of magnification substitutional intraurethral grafting (BMG) with a buccal graft [ 16 ]. The proposed method relates to methods of replacement and magnifying urethroplasty using autotransplants [ 25 ].…”

“…Thus, there is an urgent need to improve existing methods and develop new more effective methods of treatment for patients with narrowing of the proximal part of the bulbar and membranous parts of the urethra. The authors have developed and implemented an alternative method of magnifying plastic surgery of the BMU, which has demonstrated comparable effectiveness with less risk of complications [ 25 ].…”