Comparison of efficiency of vascular-preserving urethroplastic methods of the bulbo-membranous part of the urethra

Vladimir Beloborodov; Vladimir Vorobev; Alexey Kalyagin; Igor Seminskiy; Bator Sharakshinov; Sergei Popov; Olga Baklanova

doi:10.5114/wiitm.2020.94281

Comparison of efficiency of vascular-preserving urethroplastic methods of the bulbo-membranous part of the urethra

Wideochir Inne Tech Maloinwazyjne. 2021 Mar;16(1):151-162. doi: 10.5114/wiitm.2020.94281. Epub 2020 Apr 6.

Authors

Vladimir Beloborodov¹, Vladimir Vorobev¹, Alexey Kalyagin¹, Igor Seminskiy¹, Bator Sharakshinov¹, Sergei Popov¹, Olga Baklanova²

Affiliations

¹ Department of General Surgery and Anesthesiology/Academic Council, Irkutsk State Medical University, Irkutsk, Russia.
² Department of Urology, GBUZ State Oncology Hospital, Irkutsk, Russia.

Abstract

Introduction: There are several options for vessel-sparing anastomotic procedures that allow one to avoid disturbances in the normal blood supply to the spongy body and successfully perform plastic surgery of distal urethral strictures.

Aim: To perform a comparative analysis of the effectiveness of reconstructive surgical treatment of strictures of the bulbo-membranous urethra with anastomotic surgery with and without vessel-sparing.

Material and methods: A prospective study was carried out on 28 patients with a diagnosis of stricture of the bulbo-membranous urethra who underwent treatment in the period 2012-2018 in the conditions of a urological hospital of Irkutsk City Clinical Hospital No. 1. Anastomotic urethroplasty was performed using one of two methods: with full mobilization of the spongy body bulb and a vessel-sparing method when the spongy body does not intersect.

Results: The effectiveness of the classical method of anastomosing EPA-TWW ((excision and primary anastomosis urethroplasty (Turner-Warwick) and excision and Jordan's technique of vessel sparing excision and primary anastomosis)) was comparable with the method of anastomosing without crossing the (spongy body of EPA-J). Postoperative changes in the parameters of the functional status of patients based on the International Prostate Symptom Score (IPSS), International Index of Erectile Function, and Quality of Life were comparable in patients undergoing EPA-TWW and EPA-J. The final data indicate a statistically equivalent risk of developing complications such as urinary incontinence, shortening of the penis, and decreased erectile function.

Conclusions: The study did not demonstrate a statistically significant difference in the effectiveness of the treatment and the risks of complications during anastomotic surgery with or without vessel-sparing. However, an unformalized assessment demonstrates the best state of erectile function in patients after vascular-preserving surgery.

Keywords: anastomotic urethroplasty; bulbo-membranous urethra; excision and primary anastomosis (EPA); urethral stricture; vessel-sparing EPA.