465 ONE-STAGE REPAIR OF LONG BULBAR URETHRAL STRICTURES USING AUGMENTED RUSSELL DORSAL STRIP ANASTOMOSIS: OUTCOME OF 234 CASES

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One-Stage Repair Of Long Bulbar Urethral Strictures Using Augmented Russell Dorsal Strip Anastomosis: Outcome Of 234 Cases El-Kassaby A.A., El-Zayat T.

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Long term results of reconstruction of recurrent urethral strictures with buccal mucosal graft Keller H., Beier J., Dobkowicz L.

Sana Klinikum Hof, Clinic of Urology and Pediatric Urology, Hof, Germany

Ain-Shams University, Urology, Cairo, Egypt Introduction & Objectives: Long bulbar urethral strictures (>2cm) are not amenable to stricture excision and primary anastomosis procedure which may result in short urethra and chordee formation. For such strictures many procedures have been advocated including stricturotomy with subsequent graft or flap onlay, augmented anastomotic and staged procedures, of which is a combination of Russell’s technique of dorsal strip anastomosis and it’s augmentation with buccal mucosal patch graft. Our first report on this technique was in 1997, and herein we present our experience after 10 years. Material & Methods: Over a period of 10 years, 234 patients diagnosed by urethrograms as having long bulbar urethral strictures (mean 4.2cm) where managed by the augmented Russell urethroplasty. The procedure included excision of most of the diseased segment (mean 2.8cm) and anastomosis of a dorsal strip leaving an oval ventral defect. Augmentation was done in all our patients using a buccal mucosa patch graft (mean 4.7cm). Results: Mean follow-up was 36 months. Urethrograms were done at 3 weeks, 3&6 months postoperatively and if the patients were symptomatic thereafter. Urethrocystoscpy was performed at 12 and 18 months. 223 patients completed the follow up protocol and the overall success rate was 93.7% with 14 (6.3%) patients showing stricture recurrence at different intervals postoperatively. 10 of the failure group were successfully managed by single VIU, while the other 4 patients were treated by ventral penile pedicled flap. Postoperative dribbling of urine was noticed by 90 patients (40.4%), superficial skin sloughing in 15 (6.7%) patient and temporary lower lip numbness in most of the patients, yet, no major donor site complications were noted in our series. Conclusions: Augmented Russell technique proves to be beneficial for long bulbar urethral strictures, in our series 93.7% were stricture free. In the bulbar region, both ventral and dorsal onlays are applicable with nearly equal success rates. The buccal mucosa patch graft offers an excellent material for augmentation.





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Introduction & Objectives: To report our long time results of reconstruction of extended recurrent urethral strictures with buccal mucosal graft. Material & Methods: In 240 consecutive patients with extended recurrent urethral strictures operated between 1994 and 2005 in our center, buccal mucosal graft was used for reconstruction. In all patients it was the graft was placed ventrally in onlay technique. Mean stricture length ranged from 2-25 (mean 9,5) cm and the number of operative treatments before was 2-14 (mean 3,9). Patients age was 1- 80 (mean 48) years. The data were prospectively recorded by patients reported questionnaires evaluating uroflow and residual urine every 3 month in the first year and 6 monthly thereafter. In case of uroflow was less than 20ml or residual urine increased to more than 100ml or infections occurred we performed urethroscopy and or urethrography. Mean follow up was 61 (17-139) month. Results: Recurrent strictures occurred in 17 (7,1%) of our patients. Five opted for intermittent dilatation, five were managed by a single DVIU and in the other 11 a further reconstruction with buccal mucosa was performed. After a further mean follow up of 42 month (13-86) 11 out of these 16 patients (69%) were recurrence free. The overall success rate was 95,8%. Conclusions: Buccal mucosal graft implanted in onlay technique on the ventral aspect of the urethra is an excellent material for reconstruction of extended recurrent urethral strictures. Long term results are very satisfying.



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How does urethroplasty affect sexual function? A prospective study

Diagnostic application of flexible cystoscope in posterior urethroplasty

Ponce De Leon J., Gausa L., Montlleó M., Caparrós J., Villavicencio H.

Hosseini S.J., Kaviani A.

Fundació Puigvert, Urology Department, Barcelona, Spain

Shohada Tajrish Hospital, Shaheed Beheshti Medical Science University,, Reconstructive Urology, Teheran, Iran

Introduction & Objectives: Prospective study on male sexual function using IIEF questionnaire for patients undergoing urethroplasty. Material & Methods: January 2002-October 2006, IIEF questionnaire given to 50 patients to be filled before urethroplasty, and after 6-12 months of surgery. We take into account age, stricture localization, type of reconstructive urethral surgery, and division of IIEF questionnaire in its domains (erectile-function, orgasmic-function, sexual-desire, sexual-actsatisfaction and global-satisfaction), considering grades for erectile dysfunction in absence (26-30), low (17-25), moderate (11-16) or high (6-10). Results: Mean age 43.9y (20-76). Valuable patients at 6 months 42 (8 unfilled questionnaire) and at 12 months 39 (11 not yet valuable). Stricture localization: bulbar 39, anterior 10, and glandular 5 (4 double stricture). Kind of urethroplasty: End to End Bulbar 34, Webster 4, Jordan 5, Dorsal Orandi 2, Bucal Mucosa 2, Double Urethroplasty with Barbagli+Jordan 1, Asopa 1 y Remodelation Diverticular Penile Sac 1. Mean values respectively change from basal to 6m. and 12m: Erectile function 24.57, 22.69,24.55; orgasmic function 8.78, 8.24, 8.81; sexual desire 7.27, 6.52,6.89; sexual act 11.40, 10.78,10.92; global satisfaction 7.63, 7.26,8.00. Basally, there are 33 without erectile dysfunction (ED), 8 low, 6 moderate y 3 severe; 27 maintain no ED, 3 decrease to low, and 3 to severe; 8 with low ED, 5 maintained, 2 decrease to moderate and 1 to severe; 6 moderate DE, 3 increase to normal, 2 to low and 1 decreases to severe; 3 severe DE, disappears in 2 and maintains in 1; from orgasmic function 41 unchanged, 4 improve, and 5 worsen; from sexual desire 36 unchanged, 3 improve, and 11 worsen; from sexual act satisfaction 29 unchanged, 11 improve, and 10 worsen; from global satisfaction 36 unchanged, 8 improve, and 6 worsen. At 6m. erectile function (29p.) #50y. 0=25.1, while >50y. 0=17.3 (T-Student p=0.016), and at 12m. #50y. 0=27.9, while >50y. 0=18.7 (T-Student p=0.001).When dividing urethroplasty in bulbar (39) and not-bulbar (11), no statistical difference in erectile function from basal to 6m. and 12m. (T-Student p=0.33, p=0.79 and p=0.66), and in score subtraction in each group from basal to 6m. (p=0.59) and 12m. (p=0.59). Conclusions: Urethroplasty improves sexual function in 22%, does not modify in 46% and worsens in 32%. When normal erectile function, it is maintained after urethroplasty in 82%.When some kind of erectile dysfunction it improves in 40%, maintains in 35 % and worsens in 25%. Localization of stricture does not influence in erectile function outcome after urethroplasty. Age over 50 has a statistical negative influence on erectile function after urethroplasty.

Introduction & Objectives: To evaluate the diagnostic value of antegrade flexible cystoscopy before and during posterior urethroplasty. Material & Methods: We performed diagnostic antegrade flexible cystoscopy prior to and during posterior urethroplasty from 1999 to 2004. Flexible cystoscope was introduced through mature tract of suprapubic catheter. We evaluated bladder, bladder neck and posterior urethra. We looked for proximal urethral ending point, fistula and deviation. We also repeated the procedure during perineal dissection especially in cases with severe urethral end deviation. In such cases we introduced a tiny needle perineally at the proposed site of proximal urethral ending and checked it out endoscopically by flexible cystoscope to be sure that it has entered the urethra exactly at its end. In cases with severe deviation, we occasionally had to adjust the needle site once or twice before opening the proximal urethra. Results: A total of 111 patients underwent diagnostic flexible cystoscopy. Posterior urethra ended beyond external sphincter in 16 patients, 5 patients had severe deviation of posterior urethral end, 9 patients had bladder neck false passage. 1 patient had prostatic urethrorectal fistula. 1 patient had bladder rhabdomyoma. Except for a patient with urethrorectal fistula and 3 patients with bladder neck false passage, standard VCUG didn’t show the above mentioned data. The proximal urethras were opened exactly at their distal points in all cases including the cases with severe deviation. Conclusions: Antegrade flexible cystoscopy is a valuable procedure which complements voiding cystography results. It is also helpful during urethroplasty to show the exact distal point of the proximal urethra especially in cases in which we face a severely deviated posterior urethral end. So it seems to be a helpful procedure to prevent the urethral ends misalignment after urethroplasty in such complicated cases.

Eur Urol Suppl 2007;6(2):139