Clinical Original Article
The efficacy of non-transecting uerthroplasty in the management of bulbar urethral stricture
Xie Hong, Yang Tao, Luo Zhiqiang, Song Lujie, Zhang Jiong, Jin Chongrui, Hu Xiaoyong, Fu Qiang
Published 2021-08-15
Cite as Chin J Urol, 2021, 42(8): 609-614. DOI: 10.3760/cma.j.cn112330-20210414-00198
Abstract
ObjectiveTo compare efficacy and erectile function outcome of Non-transecting Urethroplasty (NTU)with excision and primary anastomotic urethroplasty(EPA) in the management of bulbar urethral stricture.
MethodA retrospective analysis of the case data of 73 patients with bulbar urethral stricture admitted to Shanghai Sixth People's Hospital from January 2016 to December 2019. The patients are 18 to 60 years old, because of the stenosis of the bulbous urethra, the length of the stenosis is less than 2 cm, and there is no history of urethral surgery, no multiple urethral stricture, and no obvious ED before surgery. According to the operation method, the patients were divided into 25 cases in NTU group and 48 cases in EPA group. The ages of the NTU group and the EPA group were (39.2±9.4) years and (42.1±9.3) years, respectively. The course of the disease was 6.0(3.0-14.0) months and 6.5(3.0-11.0) months, respectively, and the body mass index was (23.7±3.2) kg/m2 and (24.5±2.7) kg/m2, the preoperative maximum urine flow rate (Qmax) was (8.7±4.3) ml/s and (7.9±4.6) ml/s, respectively, and the length of the stenosis was respectively (1.7±0.4) cm and (1.8±0.2) cm, the preoperative International Erectile Function Questionnaire (IIEF-5) was (20.9±1.9) points and (21.3±2.1) points, respectively, the difference was not statistically significant (P>0.05). The etiology of NTU group and EPA group were 8 cases (32.0%) and 31 cases (64.6%) of trauma, 11 cases (44.0%) and 9 cases (18.8%) of iatrogenic injury, and 6 cases (24.0%) and 8 cases (16.7%), the difference was statistically significant (P=0.023). All operations were performed by the same team of doctors. The urethral scar was assessed during the operation. If the scar tissue can be completely removed without breaking the urethra, NTU is performed. The distal end of the urethra is cut at the dorsal side of the narrow segment of the urethra, and the urethral scar is removed in a transverse wedge shape. The urethra is sutured; otherwise, EPA is performed, the urethra is completely cut off, the stricture of the urethra and surrounding scar tissue is completely removed, and the urethra end-to-end anastomosis is performed. Record the operation time and intraoperative bleeding. Difficulty urinating after surgery, urethral microscopy and urethral angiography showed that the urethral stricture at the surgical site was defined as a failure of the operation. The urinary catheter was removed 3 weeks after surgery, urine flow rate was measured at 3 weeks, 6 months, and 12 months after surgery, erectile function was evaluated 12 months after surgery, and urethral angiography was performed 1 to 2 years after surgery.
ResultAll 73 operations in this study were successfully completed. The operation time of NTU group and EPA group were (67.6±11.3) min and (62.7±10.1) min, respectively, and the difference was not statistically significant (P=0.063); intraoperative blood loss was (71.6±16.2) ml and (86.0±20.8) ml, the difference was statistically significant (P=0.004). The postoperative median follow-up time was 18.0 months (13-38 months). The surgical success rates of the NTU group and EPA group were 92.0%(23/25) and 93.8%(45/48), respectively. The Qmax of the NTU group and the EPA group were (26.7±3.6) ml/s and (28.1±8.7) ml/s, (25.2±3.5) ml/s and (26.7±8.1) ml/s, (25.0±4.3) ml/s and (26.2±7.2) ml/s; the IIEF-5 scores were (21.8±1.6) and (20.6±2.9) points respectively at 12 months after operation, the difference was both No statistical significance (P>0.05). There was a statistically significant difference in IIEF-5 between NTU group and preoperative (P=0.023).
ConclusionNTU can achieve the same outcomes as EPA in the management of bulbar urethral stricture. More importantly, the continuance of bulbar urethra is attained and avoiding rupture of bulbar cavernous artery, so as to protect the blood supply of penile and erectile function. NTU is a minimally invasive, feasible surgical method, which is advised for the patients with shorter stricture segment and fewer fibrosis.
Key words:
Urethral stricture; Bulbar urethra stricture; Non-transecting corpus spongiosum; Erectile function
Contributor Information
Xie Hong
Department of Urology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai 200233, China
Yang Tao
Department of Urology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai 200233, China
Luo Zhiqiang
Department of Urology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai 200233, China
Song Lujie
Department of Urology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai 200233, China
Zhang Jiong
Department of Urology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai 200233, China
Jin Chongrui
Department of Urology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai 200233, China
Hu Xiaoyong
Department of Urology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai 200233, China
Fu Qiang
Department of Urology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai 200233, China
