Augmented Anastomotic Urethroplasty for Long Segment Bulbous Urethral Strictures

Background: During urethroplasty, if the stricture contains a 2 to 4 cm region that is particularly narrow and/or fibrotic, anastomotic repair is not ideal, so that portion may be excised with subsequent anastomosis of the ventral aspect of the urethra to shorten, widen and optimize the urethral wall onto which an onlay graft is to be placed. This procedure is termed augmented anastomotic urethroplasty Objectives: Evaluation of the outcome of augmented anastomotic urethroplasty with dorsal onlay for long segment bulbar urethral stricture. Patients and Methods: A prospective clinical trial was carried out during the period from March 2017 to September 2019 of 55 patients underwent dorsal onlay augmented anastomosis using buccal mucosa graft for long segment bulbar urethral strictures. All patients underwent pre-operative medical history taking and physical examination, sono-urethrography and voiding cystourethrogram. Patients were followed-up and re-assessed at 3 and 6 months post-operatively. Follow-up urethrography was performed at 6 months. The primary outcome was the procedure success rate defined by the successful voiding function. Stricture recurrence was defined the presence of intractable voiding symptoms or the need for any urethral interventions. The data were analyzed using the appropriate statistical tests. Results: During the study period, 55 patients completed the follow-up protocol and included in the study. The mean age was 41.93±10.70 years. The mean intra-operative stricture length was 3.39±0.59 cm. Buccal mucosal graft was used in all cases. Mean graft length was 4.15±0.62 cm. At 6 months follow up, 51 patients had no evidence of stricture recurrence and required no further intervention with an overall success rate of 92.7%. Stricture recurrence occurred in 4 patients (7.3%). No donor site major complications were detected. The urethroplasty complication rate was 20.0%, and all were minor. No effect of urethroplasty on erectile function in adult sexually active patients. No penile shortening or chordee. Conclusions: Dorsal onlay augmented anastomosis was a useful technique for long bulbar strictures. High stricture-free rates and complications are few and minor. Although longer follow up was needed.