Russian Medical Academy of Continuous Postgraduate Education
Introduction: Dorsal techniques of non-transecting anastomotic urethroplasty have certain disadvantages. Therefore, we have proposed a new technique of non-transecting anastomotic urethroplasty using ventral access. Methods: 47 men with strictures of the bulbous urethral segment of different etiologies underwent anastomotic urethral plastic surgery without full mobilization and intersection of the dorsal semicircle of the spongy body by one surgeon in the clinic of urology and surgical andrology from January 2016 to March 2022. By origin, strictures were iatrogenic – 19 (40.4%), post-infectious -22 (46.8%) and post-traumatic (blunt trauma of the perineum) – 6 (12.7%). A significant proportion of patients, 32(68%), had previously undergone surgical treatment of strictures, including internal optical urethrotomy and urethral bougienage. The average age of patients was 59 years. All patients of this group underwent our technique. Results: The average length of the strictures was 1.7 cm. The average duration of the operation accounted for 106 minutes. The average volume of blood loss was 181 ml. The median volumetric maximum urination rate was estimated 3 months after surgeries and accounted for 17.7 ml/sec. The average amount of points on the ICEF scale before and after surgical treatment did not change significantly, its median before surgery was 15 points, 3 months after surgery – 16. During the entire follow-up period, only 3 patients (6.3%) showed signs of constriction in the area of urethral anastomosis, confirmed by urethrography, uroflowmetry and also by the data of urethral calibration using a Foley catheter. Two patients already were operated with buccal graft, third still under observation. Conclusions: Considering the objective reduction in the volume of direct surgical trauma, partial preservation of innervation and blood supply to the urethra, due to the absence of mobilization of the dorsal surface of the spongy body, the absence of early and late postoperative complications, satisfactory quality of urination (93.7%), preservation of the initial level of erectile function, a low number of relapses (6.3%) during long follow–up periods, as well as the fact that this technique was carried out despite the different degree of spongiofibrosis - this variant of urethral plastic surgery after additional studies and significant observation periods can be useful. SOURCE OF Funding: there is no source of funding
