12 MODIFIED TECHNIQUE FOR LONGER BULBAR URETHRAL STRICTURES: “Z” ANASTOMOTIC REPAIR

The Journal of Urology(2012)

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You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery I1 Apr 201212 MODIFIED TECHNIQUE FOR LONGER BULBAR URETHRAL STRICTURES: “Z” ANASTOMOTIC REPAIR Raul Ordorica and Paul Bradley Raul OrdoricaRaul Ordorica Tampa, FL More articles by this author and Paul BradleyPaul Bradley Tampa, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.054AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The treatment of bulbar urethral strictures includes substitution urethroplasty as well as excision and primary anastomosis (EPA). The length of stricture that may be successfully treated with a tension-free repair limits EPA to shorter strictures. Having initially compared our results to standardized EPA (AUA – 2008), we have evaluated the “Z” anastomotic technique (ZA) in regard to longer term outcome. METHODS 35 patients with a mean age of 45 (15 to 79) underwent a modified EPA with the use of a ZA repair. Bulbar strictures were approached with a dorsal incision across the stricture following perineal exposure. For those strictures deemed short enough to undergo primary anastomosis, the urethra was divided and ZA repair was performed. The urethra is spatulated on the dorsal side of both the proximal and distal margins (fig 1). The contralateral tips of the proximal and distal urethral ends are then advanced into the opposing apexes created by the spatulation (fig 2), forming a vertical suture line along the dorsal aspect. The remaining tips are then advanced laterally in opposite directions to complete the anastomosis forming a “Z” (fig 3). The remainder of the urethra is closed without tension in 2 layers. Patients were evaluated post operatively at six month intervals with combination of AUA symptom score and complex uroflowmetry, with cystoscopy performed as indicated. RESULTS The mean urethral stricture length was 1.5cm (1.0 to 3.0). If the stricture was found to be of greater length, then repair was easily converted to oral mucosal grafting with dorsal onlay. All patients who underwent ZA repair remained without stricture recurrence with a mean follow up of 14 months (6 to 84). One patient complained of phallic shortening, with prior history of erectile dysfunction. CONCLUSIONS The “Z” anastomosis modification to the EPA repair of bulbar urethral strictures allows for the formation of a tension free repair of longer strictures without compromise of results. The dorsal approach allows for conversion to an oral mucosal dorsal onlay as required. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e5 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raul Ordorica Tampa, FL More articles by this author Paul Bradley Tampa, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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Key words
urethral strictures,anastomotic repair,longer bulbar
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