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Anastomotic Urethroplasty
Posted in Lectures on 22 May 2019

Luis Martínez-Piñeiro
Chief of Urology
Manuel Girón de Francisco
Urologist

Hospital Universitario La Paz (Madrid, Spain)

In spite of its potential impact on sexual function (mainly erectile dysfunction), anastomotic urethroplasty is currently the best technique for urethral reconstruction, when indicated. Erectile dysfunction has been described in approximately 1% of patients. It is a feasible, relatively simple and fast technique. Most authors perform this kind of surgery for strictures no longer than 2-3 cm and located in the bulbar urethra.
A proper urethral dissection is a key aspect when carrying out a urethroplasty, in order to achieve a tension-free anastomosis. On the basis of the elasticity of the urethra, it has been demonstrated to lengthen by up to 66% when mobilised and stretched. Taking into account that the bulbar urethra has an average length of 7.5 cm, and a length loss of 1 cm must be considered on each end owing to spatulation, the maximum gap length that can be bridged is about 4 cm. Bearing this in mind, in the bulbar urethra, regarding the stricture location, the more distal, the shorter the gap that can be bridged, and the more proximal, the longer the gap that can be bridged.

Anastomotic urethroplasty for penile urethra strictures should be avoided, due to the high incidence of iatrogenic ventral chordee as in distal bulbar urethra. Iatrogenic ventral chordee may be corrected by suspensory ligament release in a secondary surgery. These strictures are better managed by means of substitution techniques.

As a general rule, recovery, urinary catheterisation and the hospitalisation period are shorter in patients who undergo anastomotic urethroplasty. This, together with self-reported patient satisfaction, makes anastomotic urethroplasty an excellent procedure, safe and reproducible in most urology departments.