The Technique of Vessel Sparing Excision and Primary Anastomosis for Proximal Bulbous Urethral Reconstruction

PurposeWe present a technique not previously described for proximal bulbous or bulbomembranous urethral reconstruction of excision and primary anastomosis. The technique has the potential advantages of preserving the proximal urethral blood supply.Materials and MethodsFrom June 2003 to October 2006, 10 patients underwent vessel sparing urethral reconstruction including 3 after radical prostatectomy, 6 following straddle trauma and 1 potentially with a congenital stricture. A plane was developed between the urethra and the proximal blood supply at the bulbospongiosum, allowing for division of the urethra without dividing the spongy tissue of the corpus spongiosum or the arteries to the bulb. Only 7 patients are presented for data analysis because the other 3 have not had sufficient followup to date.ResultsPatient age range was 15 to 72 years (mean 47). The patient with a congenital stricture was 2 years old. Stricture length ranged from 0.5 to 2.5 cm (mean 1.5). The patients who had undergone radical prostatectomy were either incontinent or were believed to be possibly rendered incontinent after the urethral reconstruction. At a mean followup of 12.5 months (range 6 to 38) all 7 patients had patent urethras, 2 were incontinent and 1 underwent implantation with an AMS 800™ sphincter using a transcorporal approach. As of this writing all 10 patients are apparently stricture-free.ConclusionsPreservation of blood supply is always a noble achievement in surgery. However, it technically often requires significant effort. In patients after radical prostatectomy with proximal anterior urethral or bulbomembranous strictures, preserving the blood supply possibly decreases cuff erosion when undergoing later implantation Many patients (approximately 12% lifetime risk of prostate cancer) will require radical prostatectomy and may later require a sphincter. Further studies are warranted to evaluate the benefit of applying this technique in all suitable patients.