Double-face urethroplasty in patients with obliterative bulbar strictures post-transurethral resection of the prostate mid-term outcomes in high-volume referral center

Objective Incidences of post-transurethral resection of the prostate(post-TURP)strictures are between 2.2%and 9.8%.Stricture commonly occurs within the first 6 months.Our objective was to assess the outcomes of patients with obliterative strictures post-TURP that underwent a double-face urethroplasty.Methods This is a single-center prospective study of 17 patients with obliterative proximal bulbar stricture post-TURP who underwent double-face graft urethroplasty by two surgeons between January 2014 and January 2020.We defined post-TURP obliterative strictures as those patients who presented with complete or almost complete obstruction of the urethral lumen and who have had a history of acute urine retention.We have excluded patients with bladder neck contracture.Primary outcome was treatment success,defined as the no need for further treatments.Secondary outcome was post-urethroplasty continent rate.Results Seventeen patients were included in the study with median age of 66(interquartile range 40-77)years;median time of follow-up was 24(interquartile range 12-84)months;median stricture length was 4(interquartile range 2-6)cm.Of the 17 patients,15(88.2%)were successful.All patients were continent after urethroplasty.Conclusion With mid-term follow-up,treatment of obliterative proximal bulbar strictures with double-face buccal mucosa graft is a safe and effective procedure.Obliterative proximal bulbar strictures merit double-face urethroplasty with high-rate success and functional outcomes.

Flaps for bulbar urethral ischemic necrosis in pelvic fracture urethral injury

Bulbar urethral ischemic necrosis(BUIN)is an iatrogenic entity resulting from repeated attempts at performing anastomotic urethroplasty for pelvic fracture urethral injuries.Etiologically speaking,BUIN is related to a compromised blood supply of the bulbar urethra,which normally relies on anterograde supply from bulbar arteries and retrograde supply from recurrent branches of dorsal penile arteries,through the glans.At each transection of the bulbar urethra,both the anterograde and retrograde supplies are compromised,increasing the risk of BUIN.Even though this term is widely used among reconstructive urologists,BUIN is orphan of an accepted scientific definition.We aim to report our personal perspective on BUIN,to identify factors associated with its occurrence,and to describe the management options in these patients.