Introduction: Incidence of Post TURP strictures is between 2.2% and 9.8%. Stricture commonly occurs within the first 6 months. Common sites of stricture are meatus ,penoscrotal junction and proximal bulbar urethra. The membranous strictures are truly very proximal bulbar strictures. Recently literature review has recommended Ventral approach. We believe theses are very narrow ischemic strictures and a single side onlay gives inferior results .We present our study of Dorsal inlay with ventral onlay for ischemic Post TIRP strictures.
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Methods: This is high volume single-center prospective study of 17 patients with obliterative proximal bulbar stricture post-TURP who underwent double-face graft urethroplasty between Jan 2018 and July 2019. We define post TURP obliterative strictures as those patients who present with complete or almost complete obstruction of the urethral lumen and who have had a history of acute urine retention . We have excluded patients with bladder neck contracture. Primary outcome was treatment success, defined as the no need for further treatments. Secondary outcome was post-urethroplasty continent rate.
Preoperative a small caliber Ureteroscope is passed and guide wire inserted .Perineal incision, bulbnospongiosus is incised in midline.Bulbar urethra is incised ventrally across stricture.A dorsal incision is made in urethral plate.A BMG is harvested and inserted as dorsal inaly with ventral onlay .
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Results: Seventeen patients were included in the study with median age of 66 years (interquartile range 40–77 years); median time of follow-up was 24 months; median stricture length was 4 cm (interquartile range 2–6 cm). Of the 17 patients, 15 were successful (88.2%). All patients were continent after urethroplasty.
Conclusions: Very proximal bulbar strictures are best treated with ventral approach. Post TURP iatrogenic strictures are ischemic strictures. Such narrow near obliterative strictures should have a different approach. These patients merit a double face Urethroplasty with dorsal inlay and ventral onlay urethroplasty .