NON-TRANSECTING ANASTOMOTIC URETHROPLASTY


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Abstract

The review analyzes the results of using non-transecting anastomotic urethroplasty in men with urethral strictures. Identified 14 original studies using this technique: 13 foreign and 1 Russian. In total, this technique was applied in 704 patients. This technique was used in 85% of cases with bulbar urethral stricture, in 15% - with posterior stricture. The average length of the urethral stricture in all studies was less than 2 cm, except for two works, where the average stricture length was 2.3 cm and 3.9 cm, respectively. This technique is equally successfully applied in all etiological variants of urethral stricture. The incidence of postoperative complications in all studies using non-transecting anastomotic urethroplastyaveraged 13.7%. Postoperative complications were mostly mild and corresponded to G1 according to Clavien-Dindo classification.According to 10 out of 14 studies that evaluated the effect of surgical treatment on the occurrence of erectile dysfunction (ED), the incidence of ED de novo was on average 13.4%. The success of treatment with the use of non-transecting anastomotic urethroplastyaveraged 95% (82-100%) with a median postoperative follow-up of 27 months (6-64 months). In 4 out of 14 studies, an additional comparison was transecting versus non-transecting techniques. Non-transecting technique was not inferior to transecting technique by any criterion, but, on the contrary, exceeded it in a number of indicators, including the dynamics of sexual function after surgery.On the basis of available studies on the use of non-transecting anastomotic urethroplasty, this technique should be recognized as a highly efficient and reasonably safe method for treating short urethral strictures and recommended for widespread clinical use.

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About the authors

E. I Veliev

S.P. Botkin City Clinical Hospital; Federal State Budgetary Educational Institution of Further Professional Education «Russian Medical Academy of Continuous Professional Education» of the Ministry of Healthcare of the Russian Federation

Email: veliev@urotop.ru
MD, professor, Head of the Department of Urology of City clinical hospital named after S.P. Botkin of Moscow City Department of Health, professor at the Department of Urology and Surgical Andrology of FGBOU DPO RMANPO of Ministry of Health of Russia Moscow, Russia

A. B Bogdanov

S.P. Botkin City Clinical Hospital; Federal State Budgetary Educational Institution of Further Professional Education «Russian Medical Academy of Continuous Professional Education» of the Ministry of Healthcare of the Russian Federation

Email: abbogdanov@hotmail.com
Ph.D., urologist at the Department of Urology of City clinical hospital named after S.P. Botkin of Moscow City Department of Health, associate professor at the Department of Urology and Surgical Andrology of FGBOU DPO RMANPO of Ministry of Health of Russia Moscow, Russia

M. I Katibov

State budgetary institution of the Republic of Dagestan «City Clinical Hospital No. 1»

Email: mikatibov@mail.ru
doctor of medical sciences, chief of urology department Makhachlala, Russia

O. B Loran

Federal State Budgetary Educational Institution of Further Professional Education «Russian Medical Academy of Continuous Professional Education» of the Ministry of Healthcare of the Russian Federation

Email: oleg_loran@gmail.com
academician of RAS, MD, professor, Head of the Department of Urology and Surgical Andrology Moscow, Russia

References

  1. Stein D.M., Thum D.J., Barbagli G., Kulkarni S., Sansalone S., Pardeshi A., Gonzalez C.M. A geographic analysis of male urethral stricture aetiology and location. BJU Int. 2013;112(6):830-834. doi: 10.1111/j.1464-410X.2012.11600.x.
  2. Lee Y.J., Kim S.W. Current management of urethral stricture. Korean J Urol. 2013;54(9):561-569. doi: 10.4111/kju.2013.54.9.561.
  3. Bugeja S., Andrich D.E., Mundy A.R. Non-transecting bulbar urethroplasty. Transl Androl Urol. 2015;4(1):41-50. doi: 10.3978/j.issn.2223-4683.2015.01.07.
  4. Lv X., Xu Y.M., Xie H., Feng C., Zhang J. The Selection of Procedures in One-stage Urethroplasty for Treatment of Coexisting Urethral Strictures in Anterior and Posterior Urethra. Urology. 2016;93:197-202. Doi: 10.1016/j. urology.2016.02.051.
  5. Barbagli G., De Angelis M., Romano G., Lazzeri M. Long-term followup of bulbar end-to-end anastomosis: a retrospective analysis of 153 patients in a single center experience. J Urol. 2007;178(6):2470-2473. Doi: 10.1016/j. juro.2007.08.018.
  6. Al-Qudah H.S., Santucci R.A. Buccal mucosal onlay urethroplasty versus anastomotic urethroplasty (AU) for short urethral strictures: which is better? J Urol. 2006;175(4S):103. Doi: org/10.1016/S0022-5347(18)32580-1.
  7. Barbagli G., Lazzeri M. Reconstructive urethral surgery to be addressed at 2009 GURS meeting. AUA News 2009;14:14.
  8. Jordan G.H., Eltahawy E.A., Virasoro R. The technique of vessel sparing excision and primary anastomosis for proximal bulbous urethral reconstruction. J Urol. 2007;177(5):1799-1802.
  9. Gur U., Jordan G.H. Vessel-sparing excision and primary anastomosis (for proximal bulbar urethral strictures). BJU Int. 2008;101(9):1183-1195. doi: 10.1111/j.1464-410X.2008.07619.x.
  10. Lumen N., Hoebeke P., Oosterlinck W. Ventral longitudinal stricturotomy and transversal closure: the Heineke-Mikulicz principle in urethroplasty. Urology. 2010;76(6):1478-1482. doi: 10.1016/j.urology.2010.06.051.
  11. Andrich D.E., Mundy A.R. Non-transecting anastomotic bulbar urethroplasty: a preliminary report. BJU Int. 2012;109(7):1090-1094. doi: 10.1111/j.1464-410X.2011.10508.x.
  12. Welk B.K., Kodama R.T. The augmented nontransected anastomotic urethroplasty for the treatment of bulbar urethral strictures. Urology. 2012;79(4):917-921. doi: 10.1016/j.urology.2011.12.008.
  13. Котов С.В., Беломытцев С.В., Гуспанов Р.И., Ирицян М.М., Суренков Д.Н., Семенов М.К., Угурчиев А.М. Хирургическая техника и первые клинические результаты аугментационной анастомотической уретропластики без пересечения спонгиозного тела (операция Kodama). Урология. 2018;(5):39-44.
  14. Verla W., Oosterlinck W., Spinoit A.F., Waterloos M. A Comprehensive Review Emphasizing Anatomy, Etiology, Diagnosis, and Treatment of Male Urethral Stricture Disease. Biomed Res Int. 2019;2019:9046430. doi: 10.1155/2019/9046430.
  15. Barbagli G., Sansalone S., Romano G., Lazzeri M. Bulbar urethroplasty: transecting vs. nontransecting techniques. Curr Opin Urol. 2012;22(6):474- 477. doi: 10.1097/MOU.0b013e32835749be.
  16. Lumen N., Hoebeke P., Willemsen P., De Troyer B., Pieters R., Oosterlinck W. Etiology of urethral stricture disease in the 21st century. J Urol. 2009;182(3):983-987. doi: 10.1016/j.juro.2009.05.023.
  17. Hampson L.A., McAninch J.W., Breyer B.N. Male urethral strictures and their management. Nat Rev Urol. 2014;11(1):43-50. Doi: 10.1038/ nrurol.2013.275.
  18. Joshi P., Kaya C., Kulkarni S. Approach to bulbar urethral strictures: Which technique and when? Turk J Urol. 2016;42(2):53-59. Doi: 10.5152/ tud.2016.12989.
  19. Xu Y.M., Song L.J., Wang K.J., Lin J., Sun G., Yue Z.J., Jiang H., Shan Y.X., Zhu S.X., Wang Y.J., Liu Z.M., Li Z.H., Liu Z.H., Chen Q.K., Xie M.K. Changing trends in the causes and management of male urethral stricture disease in China: an observational descriptive study from 13 centres. BJU Int. 2015;116(6):938-944. doi: 10.1111/bju.12945.
  20. Zhou S.K., Zhang J., Sa Y.L., Jin S.B., Xu Y.M., Fu Q., Lazzeri M. Etiology and Management of Male Iatrogenic Urethral Stricture: Retrospective Analysis of 172 Cases in a Single Medical Center. Urol Int. 2016;97(4):386- 391.doi: 10.1159/000444592.
  21. Котов С.В., Беломытцев С.В., Гуспанов Р.И., Семенов М.К., Ирицян М.М., Угурчиев А.М. Ятрогенные стриктуры уретры у мужчин. Урология. 2018;(4):56-63.
  22. Dindo D., Demartines N., Clavien P.A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213. doi: 10.1097/01. sla.0000133083.54934.ae.
  23. Virasoro R., Zuckerman J.M., McCammon K.A., DeLong J.M., Tonkin J.B., Capiel L., Rovegno A.R., Favre G., Giudice C.R., Eltahawy E.A., Gur U., Jordan G.H. International multi-institutional experience with the vessel-sparing technique to reconstruct the proximal bulbar urethra: mid-term results. World J Urol. 2015;33(12):2153-2157. doi: 10.1007/s00345-015-1512-9.
  24. Lumen N., Poelaert F., Oosterlinck W., Lambert E., Decaestecker K., Tailly T., Hoebeke P., Spinoit A.F. Nontransecting Anastomotic Repair in Urethral Reconstruction: Surgical and Functional Outcomes. J Urol. 2016;196(6):1679-1684. doi: 10.1016/j.juro.2016.06.016.
  25. Gomez R.G., Campos R.A., Velarde L.G. Reconstruction of Pelvic Fracture Urethral Injuries With Sparing of the Bulbar Arteries. Urology. 2016;88:207-212. doi: 10.1016/j.urology.2015.09.032.
  26. Anderson K.M., Blakely S.A., O’Donnell C.I., Nikolavsky D., Flynn B.J. Primary non-transecting bulbar urethroplasty long-term success rates are similar to transecting urethroplasty. Int Urol Nephrol. 2017;49(1):83-88. doi: 10.1007/s11255-016-1454-1.
  27. Ivaz S., Bugeja S., Frost A., Andrich D., Mundy A.R. The Nontransecting Approach to Bulbar Urethroplasty. Urol Clin North Am. 2017;44(1):57-66.doi: 10.1016/j.ucl.2016.08.012.
  28. Le W., Li C., Zhang J., Wu D., Liu B. Preliminary clinical study on nontransecting anastomotic bulbomembranous urethroplasty. Front Med. 2017;11(2):277-283. doi: 10.1007/s11684-017-0515-x.
  29. Waterloos M., Verla W., Oosterlinck W., François P., Lumen N. Excision and Primary Anastomosis for Short Bulbar Strictures: Is It Safe to Change from the Transecting towards the Nontransecting Technique? Biomed Res Int. 2018;2018:3050537. doi: 10.1155/2018/3050537.
  30. Chapman D.W., Cotter K., Johnsen N.V., Patel S., Kinnaird A., Erickson B.A., Voelzke B., Buckley J., Rourke K. Nontransecting Techniques Reduce Sexual Dysfunction after Anastomotic Bulbar Urethroplasty: Results of a Multi-Institutional Comparative Analysis. J Urol. 2019;201(2): 364-370. doi: 10.1016/j.juro.2018.09.051.
  31. Verla W., Oosterlinck W., Waterloos M., Lumen N. Vessel-sparing Excision and Primary Anastomosis. J Vis Exp. 2019;(143). doi: 10.3791/58214.
  32. Котов С.В. Анастомотическая уретропластика без пересечения спонгиозного тела - новый метод уретропластики для лечения коротких стриктур бульбозного отдела уретры. Экспериментальная и клиническая урология. 2015;(3):62-66.

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