Non-transecting anastomotic augmented uretroplasty with dorsal onlay buccal graft for the treatment of bulbous urethral strictures: Results and complications

Abstract

Introduction : Urethroplasty is the gold standard for the management of urethral strictures. For obliterative bulbar strictures longer than 2 cm, excision primary anastomosis (EPA) cannot be optimally performed, and staged urethroplasty is recommended. To minimize multiple interventions, Augmented Anastomotic Urethroplasty (AAU) was developed. Incorporating the vessel-sparing approach without the transection of the spongiosum would improve the results of urethroplasty and limit complications. Our study aimed to assess the outcomes of non-transecting Anastomotic Augmented Urethroplasty with a buccal graft (ntAAU). Method : From 2019 to 2023, 42 patients underwent ntAAU. Anatomical success was defined as the ability to pass a cystoscope (16,5 Fr) and functional success was determined by a maximum urinary flow rate (Qmax) greater than 15 ml/s. Clinical outcomes were evaluated using patient reported outcome concerning urinary function (USP dysuria, VPPS, six items LUTS, questions 7, 9, 10 from USS-PROM) and erectile function (IIEF-5, EHS). Results : Anatomical success rate was 90.5% and functional success was 83.3% with a median (IQR) follow-up of 18 (12.5–28.5) months. The complication (urinary infection, suprapubic catheter obliteration, abscess, bleeding) rate was 14.2%. Questionnaires were avaiblable for 31 patients. Median (IQR) USP dysuria score was 0 (0–1), VPPS score was 7 (3–12), and six-item LUTS score was 4 (2–9). The median (IQR) IIEF-5 score was 22 (15.5–25) and EHS score was 3.5 (2–4). Patients with treatment failure were managed with redo-urethroplasties. Conclusion : This technique shows good outcomes and appears to be a valuable option for managing long strictures with an obliterative part.