Augmented Anastomotic Urethroplasty Dr Ahmed Mahmoud Riad Lecture

Augmented Anastomotic Urethroplasty Dr. Ahmed Mahmoud Riad Lecture of Urology and Reconstructive surgery, Sohag university

Introduction • A short bulbar stricture of 1 cm. or less is generally manageable by excision and re-anastomosis, particularly if it has a traumatic etiology. • Longer strictures greater than 2 to 3 cm. are often inflammatory in origin and onlay repair using a graft of penile skin or buccal mucosa, or a pedicled island flap of penile skin is most commonly performed because there is considerable risk of penile chordee or shortening if more than 2 cm. of urethra are excised.

What is augmented anastomotic urethroplasty? • Turner-Warwick described a type of urethroplasty combining the principles of excision and re-anastomosis with substitution using a graft or flap to manage bulbar strictures in the gray zone, in which direct anastomosis may be under tension and further urethral mobilization to relieve tension may risk penile chordee or shortening. • GEORGE D. WEBSTER called this repair The Augmented Anastomotic Urethroplasty.

Augmented Russell Dorsal Strip Anastomosis

Results • We performed a retrospective analysis of 55 patients with long bulbar urethral stricture had done bulbar urethroplasty in form of augmented anastomotic repair, from 2012 to 2017. • We divided our patients into 2 groups, group (A) had done dorsal strip anastomosis and group (B) had done ventral strip anastomosis with corresponding free graft augmentation using buccal or penile skin grafts.

Results • Overall success rate was 87% with no significant difference between both groups. • As regard complication, post void dribbling was significant in group (A) about 50% of cases, group (B) was 14%. • Also perineal fistula was developed in 2 (7. 1%) cases in group (A) but without significant difference between both groups.

GEORGE D. WEBSTER reported 93% success rate in 29 patients , 44% post void dribbling. Abdel W. El-Kassaby reported 93. 7% success rate in 243 patients, 40. 4% post void dribbling. Nathan Y. Hoy reported 96. 9% success rate in 163 patients, 41. 7% post void dribbling. Abouassaly reported 90% success rate in 62 patients. Virasoro R et al. reported 96. 9% success rate in 65 patients, 41. 7% post void dribbling.

Conclusion. • Augmented anastomotic urethroplasty is a useful technique for bulbar strictures that are too long to be managed by excision and primary anastomosis or long bulbar urethral stricture has focal segment of obliteration • Ventral and Dorsal onlays are applicable with nearly equal success rates.

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