Urethroplasty - Augmented Anastomosis

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If a patient has a long bulbar stricture the original stricture is usually short and tight. The concept is to excise this short and tight stricture and spatulate the urethra on both sides and anastomos the urethra to form flat urethral plate. A buccal mucosa graft is used as patch of augmentation either on ventral or dorsal side. The BMG takes care of the gray urethra on both sides of the stricture. Ultimately the short and tight stricture is excised and the remaining bulbar urethra is augmented achieving good results.

Indications

The indications are:

  1. long bulbar stricture with bad urethral plate
  2. long bulbar stricture with a short and tight segment

Procedure

Under anesthesia as in Barbagli’s urethroplasty the bulbar urethra is mobilized and spatulated dorsally. The short and tight segment (less than 1.5cm) of the bulbar urethra is excised. A 1.5cm wide and 6 cm long BMG is spread and fixed on the corpora cavernosa. The ventral urethral plate is reconstituted by anastomosing the proximal and distal urethral ends. The urethral plate is now flat and is sutured to the buccal mucosa graft as in Barbagli’s technique.  Rest of the management is similar to Barbagli’s urethroplasty.

Initially, I was enthusiastic and performed many of these procedures. But according to my current concept of not transecting the bulbar urethra for non traumatic strictures has shifted my thinking away from augmented anastomosis.  Barbagli