Short bulbar urethra stricture - Surgical options

Dear All, 

30 year patient with very thin stream since 5 years. 
Before 4 years VIU of his stricture was done at other center at that time he was just married. 
Now he has one child. 
After VIU he was voiding well for six months. He was not regular in CIC.  Which he has stopped since 3 years. 
Is he still case for one more VIU with CIC? 
Urethroplasty :
End to end 
Augmented anastomotic 
Ventral onlay 
Dorsal only 
Please opine 

Short bulbar urethra stricture - Surgical options


  • Jaideep Mahajani
    Jaideep Mahajani
    20 Feb 2020 02:21:42 PM

    Ventral Onlay Grafting will be my choice. He is young, so there should be minimum manipulation to avoid erectile dysfunction. And secondly results of DOG & VOD are comparable. VOG is easy procedure for mid & distal bulbar stricture. 

    Secondly I think CIC terminology should not be used for self dilatation. CIC was described by Lapides for neurogenic bladder; where urethral is normal, hence is not a traumatic procedure . Where as self dilatation is certainly a traumatic procedure. 

  • Utsav Shah
    Utsav Shah
    20 Feb 2020 02:38:31 PM

    Respected Sir,

    A young patient with short segment stricture with no H/O trauma, already treated with DVIU is a candidate for augmentation urethroplasty because:
    1)Success rate of DVIU if done again i.e. 2nd time will be 30-40% 
    2)Inflammatory strictures have longer invisible length of spongiofibrosis against straddle injuries which result in deep spongiofibrosis
    3)Excision and primary anastomosis though a viable option, becomes unreliable once the urethra is opened up as the segment generally tends to be >1.5cm inspite of the short segment visible on retrograde urethrogram. 
    4)As Jaideep sir has rightly pointed out, DOG and VOG both can be done. I have seen and assisted more of DOG and would attempt the same in this patient. 

    Pls feel free to criticise and correct my answer if I’m wrong. 
    Thank you. 

  • Dr. Anil Takvani
    Dr. Anil Takvani
    20 Feb 2020 04:25:38 PM

    Thanks Jaydeep.

    Once again congratulations to Utsav to post replay like an expert, once again you are the first trainee to do so. I hope others will emulate it.
    My questions:
    Why not to cut it, anastomosis posteriorly end to end and augment anteriorly with buccal mucosa?
    Do you thing segment is too narrow? In that case double graft, one at dorsal and second ventral opening stricturous urethra ventrally is better option?

  • Amit D. Trivedi
    Amit D. Trivedi
    20 Feb 2020 05:05:16 PM

    It’s non traumatic stricture so In my opinion dorsal BMG with ventral mucosa to mucosa anastomoses after cutting gray mucosa ( augmented anastomotic without cutting bulb)

  • Prabir Basu
    Prabir Basu
    21 Feb 2020 11:17:47 PM

    Why at all transect or augment here? I would have preferred a dorsal stricturoplasty. The short segment stricture is in the distal bulb so the bulb doesn't need much of mobilization towards its attachment with perineal body . A terumo glidewire can easily pass through and a heinke miculicz repair won't be a big issue.

  • Rahul Kapoor
    Rahul Kapoor
    24 Feb 2020 09:13:40 AM

    This is common scenario. 

    Its right that BMG urethroplasty is better option in this patient and either ventral or dorsal can be done.
    But seeing the result of VIU, i will discuss Re VIU with him. 
    I dont do CIC in stricture patients. 

  • Amilal Bhat
    Amilal Bhat
    05 Mar 2020 09:50:24 AM

    There is spongiofibrosis both proximal and distal , Stricturoplasty in spongiofibrosis is likely to compromise the results. Similarly there may tension on suture / chordee if we go for end to end .I prefer dorsal onlay BMG but as per literature both dorsal / ventral onlay any one can be done 

    Amilal  Bhat

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