Objective: To present a novel surgical approach to performing bulbar urethroplasty and to assess its initial outcomes and safety.
Materials and methods: From January 2016 to March 2019, anastomotic urethroplasty without full mobilization and dissection of corpus spongiosum dorsal semicircumference was performed in 8 males with bulbar strictures by a single surgeon. Patients were given uroflowmetry, urethrography, and International Index of Erectile Function (IIEF) questionnaires at their 3- and 12- month follow-up visits postoperatively.
Results: Mean stricture length was 2.3 cm (±0.59 cm) and mean surgery time was 131 minutes. No early or late postoperative complications were observed. Median maximum flow rate (Qmax) assessed 3 months after surgery was 22.35 mL/sec (±6.4 mL/sec). There were no significant changes in median IIEF score postoperatively (preoperative IIEF = 18.4 vs postoperative IIEF = 19.6; P >.05). During patients' 1-year observation period, no signs of constriction in the anastomosis were revealed with urethrography. One of the limitations of this technique is a necessity of more precise corpus spongiosum preparation to ensure perioperative hemostasis and good visualization. This outcome may, however, require additional time and increased blood loss during a surgeon's learning curve of the procedure.
Conclusion: The initial experience of this minimally invasive urethroplasty technique showed high efficiency and no early stricture recurrences. However, the clinical significance of additional preservation of innervation and blood supply, the potential to further optimize this technique's functional outcomes, and applicability of this technique in patients with spongiofibrosis requires further investigation. Our results make it possible to consider this technique as a possible alternative to classic anastomotic urethroplasty.
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