Non-transecting anastomotic augmented urethroplasty with dorsal onlay buccal graft for the treatment of bulbous urethral strictures: results and complications.

Abstract

<h4>Introduction</h4>Urethroplasty is the gold standard for the management of urethral strictures. For obliterative bulbar strictures longer than 2 cm, excision primary anastomosis (EPA) cannot be optimally performed, and staged urethroplasty is recommended. To minimize multiple interventions, Augmented Anastomotic Urethroplasty (AAU) was developed. Our hypothesis was that incorporating the vessel sparing approach would improve the results of urethroplasty. and limit complications. Our study aimed to assess the outcomes of non-transecting Anastomotic Augmented Urethroplasty with a buccal graft (ntAAU).<h4>Method</h4>From 2019 to 2023, 42 patients underwent ntAAU. Anatomical success was defined as the ability to pass a cystoscope (16,5 Fr) and functional success was determined by a maximum urinary flow rate (Qmax) greater than 15 ml/s. Clinical outcomes were evaluated using patient reported outcome concerning urinary function (USP dysuria, VPPS, six items LUTS, questions 7, 9, 10 from USS-PROM) and erectile function (IIEF-5, EHS).<h4>Results</h4>Anatomical success rate was 90.5% and functional success was 83.3% with a median (IQR) follow-up of 18 (12.5-28.5) months. The complication (urinary infection, suprapubic catheter obliteration, abscess, bleeding) rate was 14.2%. Questionnaires were avaiblable for 31 patients. Median (IQR) USP dysuria score was 0 (0-1), VPPS score was 7 (3-12), and six-item LUTS score was 4 (2-9). The median (IQR) IIEF-5 score was 22 (15.5-25) and EHS score was 3.5 (2-4). Patients with treatment failure were managed with redo-urethroplasties.<h4>Conclusion</h4>This technique shows good outcomes and appears to be a valuable option for managing strictures with an obliterative part.