Nontransecting Anastomotic Urethroplasty Via Ventral Approach Without Full Mobilization of the Corpus Spongiosum Dorsal Semicircumference

Богданов, А. Б.; Велиев, Е И; Соколов, Е. А.; Metelev, Aleksei Yu.; Ivkin, Eugeny E.; Томилов, А. А.; Велиев, Р. А.; Marchenko, V. V.; Monakov, D M; Katibov, M.I.; Afyouni, Andrew Shea; Furr, J. R.; Okhunov, Zhamshid; Sabanegh, Edmund

doi:10.1016/j.urology.2020.10.074

Cited by 2 publications

(6 citation statements)

References 8 publications

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“…In our cohort, MANTA urethroplasty provided an overall success rate of 93%, which is well in line with historical AAU and ntAAU series [5,12,16,17]. However, it should be noted that, to the best of our knowledge, we are the first to present long-term data with a median follow-up of almost 4 years, and Kaplan-Meier analyses resulted in 94% re-treatment-free survival at 36 months postoperatively.…”

Section: Discussionsupporting

confidence: 85%

“…Topographically the dorsal concave aspect of the stenotic urethra is shorter compared to the convex ventral part. Thus, approaching the longer segment ventrally allows for a better anatomical reconstruction, as the dorsal aspect remains fixated and hence, the tension on the anastomosis can be minimised [12]. Further, augmentation seems more reasonable in the reconstruction of the greater ventral distance with buccal mucosa representing the graft of choice due to its histological features, elasticity, and durability [3].…”

Section: Discussionmentioning

confidence: 99%

“…Detailed responses to baseline and postoperative PROMs are depicted in Tables S1-S3. The six-item LUTS score, as derived from the USS PROM, significantly improved from a baseline median (IQR) score of 13 (8)(9)(10)(11)(12)(13)(14) to postoperative median (IQR) score of 3.5 (1-8) (P < 0.001). In sexually active patients, there were no differences in the median baseline vs postoperative IIEF-EF scores (median [IQR] 27 [17][18][19][20][21][22][23][24][25][26][27][28][29][30] vs 24 [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]; P = 0.4).…”

Section: Patient-reported Outcomesmentioning

confidence: 97%

“…Against this backdrop, non-transecting techniques have come of age to improve the aforementioned secondary outcomes. In a first step, EPA was refined using a non-transecting approach (ntEPA) [11] and the need of urethral mobilisation could be reduced by establishing a ventral access [12,13]. Results from the VeSpAR trial (ClinicalTrials.gov identifier: NCT03572348) are eagerly awaited to assess the noninferiority of ntEPA compared to conventional transecting EPA in terms of failure-free survival and functional outcome parameters [14].…”

Section: Introductionmentioning

confidence: 99%

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Mucomucosal anastomotic non‐transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures

et al. 2023

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ObjectivesTo present a surgical modification for the repair of bulbar urethral strictures containing short, highly obliterative segments and report on long‐term objective and patient‐reported outcomes.Patients and methodsWe considered patients undergoing bulbar buccal mucosal graft urethroplasty (BMGU) between July 2016 and December 2019. Eligibility criteria for mucomucosal anastomotic non‐transecting augmentation (MANTA) urethroplasty were strictures of ≥2 cm with an obliterative segment of ≤1.5 cm. The stricture is approached ventrally to avoid extensive dissection and mobilisation. Dorsally, the scar is superficially excised and the spongiosum is left intact. Dorsal mucomucosal anastomosis is complemented by ventral onlay graft. Perioperative characteristics were prospectively collected including uroflowmetry data and validated patient‐reported outcome measures on voiding, erectile, and continence function. We evaluated functional follow‐up, incorporating patient‐reported (lower urinary tract symptoms [LUTS] score) and functional success. Recurrence was defined as need of re‐treatment.ResultsOf 641 men treated with anterior BMGU, 54 (8.4%) underwent MANTA urethroplasty. Overall, 26 (48%) and 45 (83%) had a history of dilatation and urethrotomy, respectively, and 14 (26%) were redo cases. Location was bulbar in 38 (70%) and penobulbar in 16 patients (30%), and the mean (SD) graft length was 4.5 (1.4) cm. At a median (interquartile range) follow‐up of 41 (27–53) months, the functional success rate was 93%. Whereas the median LUTS score significantly improved from baseline to postoperatively (13 vs 3.5; P < 0.001), there was no change in erectile function (median International Index of Erectile Function – erectile function domain score 27 vs 24) or urinary continence (median International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form sum score 0 vs 0; all P ≥ 0.4). All patients were ‘satisfied’ (27%) or ‘very satisfied’ (73%) with the outcome of their operation.ConclusionWith excellent long‐term objective and patient‐reported outcomes, MANTA urethroplasty adds to the armamentarium for long bulbar strictures with a short obliterative segment.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Patient-reported Outcomesmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Mucomucosal anastomotic non‐transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures

et al. 2023

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“…Использованный для сканирования уретры протокол МРт приведён в таблице 1. [8,9]. у всех пациентов, у которых был выявлен спонгиофиброз (5 пациентов), рубцовые изменения располагались по вентральной поверхности спонгиозного тела.…”

Section: материалы и методыunclassified

Static MRI for diagnosis of bulbous urethral strictures and assessment of spongiofibrosis grade

et al. 2023

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Introduction. Insufficient sensitivity and specificity of existing methods for diagnosing urethral stricture require more accurate methods, which may include magnetic resonance imaging (MRI).Objective. To study the possibilities of MRI to assess the extent of bulbous urethral stricture and spongiofibrosis grade.Materials & methods. The study included six men with bulbous urethral stricture, who underwent non-transecting anastomotic urethroplasty via ventral approach. Before surgery, all patients underwent retrograde urethrography according to the standard method and urethral MRI according to their own method, and their data were compared with intraoperative parameters.Results. The length of the stricture according to retrograde urethrography averaged 11.5 ± 6.3 mm, MRI — 17.8 ± 10.9 mm, intraoperative measurement — 16.7 ± 9.1 mm. There was a significant difference between the mean length of the stricture according to retrograde urethrography and the mean length according to intraoperative data (p = 0.028). There was no significant difference between the mean stricture length according to MRI data and the mean stricture length according to intraoperative data (p = 0.085). The length of spongiofibrosis according to MRI was 15.8 ± 13.6 mm on average, and 16.7 ± 12.9 mm according to intraoperative measurements. There was no significant difference between the average length of spongiofibrosis according to MRI and the average length according to intraoperative data (p = 0.092).Conclusions. MRI provides information comparable to intraoperative data on the extent of urethral stricture, location, and spongiofibrosis grade.

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Nontransecting Anastomotic Urethroplasty Via Ventral Approach Without Full Mobilization of the Corpus Spongiosum Dorsal Semicircumference

Cited by 2 publications

References 8 publications

Mucomucosal anastomotic non‐transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures

Mucomucosal anastomotic non‐transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures

Static MRI for diagnosis of bulbous urethral strictures and assessment of spongiofibrosis grade

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