Anastomotic Urethroplasty with Double Layer Continuous Running Suture Re-Anastomosis Versus Interrupted Suture Re-Anastomosis for Infective Bulbar Urethral Strictures: A Prospective Randomised Trial

Frederik M Claassen; Francisco E Martins; Shingai B A Mutambirwa; Linda Potgieter; Lezelle Botes; Harry F Kotze; Francis E Smit

doi:10.3390/jcm11154252

Anastomotic Urethroplasty with Double Layer Continuous Running Suture Re-Anastomosis Versus Interrupted Suture Re-Anastomosis for Infective Bulbar Urethral Strictures: A Prospective Randomised Trial

J Clin Med. 2022 Jul 22;11(15):4252. doi: 10.3390/jcm11154252.

Authors

Frederik M Claassen¹, Francisco E Martins², Shingai B A Mutambirwa³, Linda Potgieter⁴, Lezelle Botes⁵, Harry F Kotze⁴, Francis E Smit⁴

Affiliations

¹ Department of Urology, Faculty of Health Sciences, University of the Free State, Bloemfontein 9301, South Africa.
² School of Medicine, University of Lisbon, Santa Maria Hospital, 1649-004 Lisboa, Portugal.
³ Department of Urology, Sefako Makgatho Health Sciences University, Dr George Mukhari Academic Hospital, Ga-Rankuwa 0208, South Africa.
⁴ Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein 9301, South Africa.
⁵ Department of Health Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, Bloemfontein 9301, South Africa.

Abstract

Introduction: The objective of this study was to compare a double-layer running suture re-anastomosis urethral stricture repair with early catheter removal to the conventional interrupted suture re-anastomosis after excision of a bulbar urethral stricture.

Methods: A consecutive series of patients with bulbar urethral stricture were enrolled in the study. The patients were randomized into two groups according to an odd/even serial number distribution. Patients' medical records were analyzed for demographics, stricture characteristics, and lower urinary tract obstructive symptoms. The outcomes were based on the presence/absence of obstructive voiding symptoms, and retrograde urethrography (RGU) performed on the first post-operative day in Group 1 and in both groups (Groups 1 and 2) at six weeks after surgery. Flexible urethroscopy was only performed on specific cases where RGU was unclear both pre- and post-operatively or when clinical recurrence was suspected. The minimum follow-up (FU) was 18 months. Success was defined as no need for subsequent dilatation, direct vision internal urethrotomy (DVIU), or urethroplasty.

Results: A total of thirty-six patients with a mean age of 45 years (range 20 to 69 years) with bulbar urethral stricture were included in this study. Group 1 and Group 2 included 19 and 17 patients, respectively. Two patients were lost during randomization and subsequently to FU. The average stricture lengths were comparable between the two groups according to the retrograde urethrogram: 1.20 cm (range 0.6 to 2) in Group 1 and 1.27 cm (range 0.5 to 2.4) in Group 2, respectively (p = 0.631). The success rate for Group 1 was 90% after a mean follow-up of thirty-six months (range 20 to 40), which was clinically significant compared to the 71% in Group 2 after a mean FU of thirty-three months (range 19 to 40; p = 0.0218; 95% CI: 0.462-41.5766).

Conclusions: Anastomotic urethroplasty (AR) performed with a double layer re-anastomosis had a cure rate comparable to the conventional anastomosis with interrupted sutures after a follow-up of eighteen months and longer. The urethral catheter can be safely removed within twenty-four hours after the excision of stricture and double-layer re-anastomosis.

Keywords: anastomotic urethroplasty; bulbar urethral stricture; urethral stricture.

Grants and funding

This research received no external funding.