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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2017, Vol. 11 Issue (2) : 277-283     DOI: 10.1007/s11684-017-0515-x
RESEARCH ARTICLE |
Preliminary clinical study on non-transecting anastomotic bulbomembranous urethroplasty
Wei Le1,2, Chao Li1(), Jinfu Zhang3, Denglong Wu1, Bo Liu1
1. Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
2. Department of Reproduction and Andrology, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
3. Department of Reproduction and Andrology, Tongren Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200050, China
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Abstract  

This study aims to investigate the effect of non-transecting anastomotic urethroplasty for treatment of posterior urethral stricture. A total of 23 patients with traumatic posterior urethral stricture were enrolled and then divided into two groups. In one group, 12 patients underwent non-transecting anastomotic urethroplasty. In the other group, 11 patients underwent conventional posterior urethra end-to-end anastomosis. The effect of operation was evaluated using the following parameters: the bleeding amount during operation, operation time, IIEF-5 scores after operation, maximum flow rate (Qmax), and rating scale of quality of life (QoL). The comparison between the conventional posterior urethra end-to-end anastomosis group and the non-transecting anastomotic urethroplasty group showed no significant difference with regard to average operation time. However, a significant difference was observed between the groups with regard to the bleeding amount during operation. The patients in the group of non-transecting anastomotic urethroplasty urinated smoothly after the removal of catheter. Meanwhile, one patient from the group of conventional posterior urethra end-to-end anastomosis had difficulty urinating after the removal of catheter. Furthermore, significant differences in the operation time, bleeding amount during operation, IIEF-5 scores after operation, and rating scale of QoL were observed, whereas no significant difference was observed between urine flow rates of the two groups after operation. Overall, non-transecting anastomotic urethroplasty is effective for posterior urethra reconstruction, and it can reduce the occurrence rate of erectile dysfunction after operation.

Keywords anastomotic urethroplasty      transecting      posterior urethra reconstruction     
Corresponding Authors: Chao Li   
Just Accepted Date: 16 March 2017   Online First Date: 19 April 2017    Issue Date: 01 June 2017
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0515-x     OR     http://academic.hep.com.cn/fmd/EN/Y2017/V11/I2/277
Fig.1  Preoperative staging via combined cystogram/retrograde urethrogram reveals a 2-cm urethral defect.
Fig.2  Cutting the corpus spongiosum at the proximal end of posterior urethral stricture.
Fig.3  Vertically cutting urethra at the dorsal part of the proximal and distal ends of stricture section.
Fig.4  Suturing the incision of the distal and proximal ends with assimilable thread. The urethra was sutured at the lithotomy positions of 1, 3, 5, 6, 7, 9, 11, and 12 after silicone catheters were imbedded.
Fig.5  Effect drawing of the incision suture of the distal and proximal ends of the urethra. Completed corpus spongiosum after end-to-end anastomosis, which was conducted after the incision at the distal and proximal ends of the stricture section.
Fig.6  Postoperative voiding cystourethrography demonstrates successful reconstruction after abdominoperineal urethroplasty.
Separating corpus spongiosum groupNon-transecting corpus spongiosum groupPvalue
Operation time (min)134.10±10.46128.50±12.150.256
Tab.1  Operation time of the two groups of patients
Separating corpus spongiosum groupNon-transecting corpus spongiosum groupP value
Bleeding volume during operation (ml)404.55±117.33316.67±64.990.035
Tab.2  Bleeding volume during operation of the two groups of patients
Before operationOne month after operationSix months after operation
Separating posterior urethra end-to-end anastomosis2.09±2.1618.77±1.9717.63±1.96
Non-transecting posterior urethra end-to-end anastomosis2.16±2.3617.87±2.1517.04±1.85
Tab.3  Change in the Qmax of patients receiving separating and non-transecting posterior urethra operations
Before operationSix months after operation
Separating urethra anastomosis15.90±2.028.72±4.05
Non-transecting urethra anastomosis16.75±2.2215.00±3.86*†
Tab.4  Change in the erectile function index (IIEF-5) of patients before and after receiving separating corpus spongiosum urethroplasty and non-transecting corpus spongiosum urethroplasty
Before operationSix months after operation
Separating urethra anastomosis3.09±0.7004.36±1.12
Non-transecting urethra anastomosis2.91±0.9003.25±1.05*†
Tab.5  Change in the QoL rating of patients before and after receiving separating corpus spongiosum urethroplasty and non-transecting corpus spongiosum urethroplasty
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