Open Access Research Article

Traumatic Bulbar Urethral Stricture: Improvised Reconstruction with Muscle and Nerve Sparing Approach

Mukesh Chandra Arya1*, Ankur Singhal2, Ajay Gandhi2, Yogendra Shyoran2, Mahesh Sonwal2 and Rakesh Singh2

1Professor and Head, Department of urology, Sardar Patel medical college, Bikaner, Rajasthan, India.

2Department of urology, Sardar Patel medical college, Bikaner, Rajasthan, India.

Corresponding Author

Received Date: October 20, 2020;  Published Date: November 13, 2020


Introduction: Anastomotic urethroplasty in traumatic bulbar stricture is successful in 90-95% of cases, but for post-void dribble and ejaculatory dysfunction (EjD). Here, we present modified muscle and nerve-sparing urethroplasty to overcome these problems.

Material and Methodology: A retrospective analysis (from January 2015- January 2019) of 55 patients with traumatic bulbar stricture managed by standard urethroplasty (Group 1, N=30) and modified urethroplasty (Group2, N=25) was done. The comparison also included their post-operative EjD and post-void dribble.

Results: Mean age of patients was 31.12 (15-55) years. Mean length of stricture was 1.41 [1-2] cm. Mean Qmax was 27.8 and 26.4ml/s in the modified and standard urethroplasty group (P-value>0.05). EjD was calculated for each patient using questions from male sexual health questionnaire (MSHQ)and MSHQ mean scores pertaining to ejaculation had a significant difference between Group1 and Group2 with mean postoperative scores of 14.17 and 21.12 respectively (p-value- <0.005) At 1-year, ten patients (33%) from Group 1 while one patient (4%) in the Group 2 showed post-void dribbling respectively (P-value-0.007).

Discussion: Success rate (patient not needing post-operative intervention) was 100% in modified and 96.66% in standard urethroplasty group. Results in terms of EjD and post-void dribble were statistically significant.

Conclusion: In traumatic bulbar stricture, muscle and nerve-sparing urethroplasty is associated with statistically significant better outcomes in terms of EjD and post-void dribble.

Keywords: Muscle-sparing urethroplasty; End to end urethroplasty; EPA; Traumatic bulbar stricture; Stricture urethra

Abbreviations: EjD: Ejaculatory dysfunction; Qmax: maximum urine flow rate; MSHQ: male sexual health questionnaire; Qmax: Maximum Urine Flow Rate; RGU: Retrograde Urethrogram; SPC: Suprapubic Cystostomy; MCU: Micturating Cystourethrogram; PGA: polyglycolic Acid; DVIU: Direct Visual Internal Urethrotomy

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