Proximal bulbar urethroplasty via extended anastomotic approach--what are the limits?

We report our initial experience with men who underwent EAU for strictures greater than 2.5 cm involving the proximal bulbar urethra.

Of the more than 250 men who underwent urethral reconstruction at our institution during 1997 to 2005 a select consecutive group of 22 in whom proximal bulbar urethral strictures were treated with primary bulbomembranous anastomosis were evaluated. Outcomes in men with strictures greater than 2.5 cm long (EAU) were compared to those in men with shorter strictures in the same proximal bulbar location. Cases of post-traumatic urethral disruption related to pelvic fractures were omitted. American Urological Association symptom index scores and erectile function questionnaires were completed more than 6 months postoperatively. Results of a prior study using the same erectile function questionnaire after various types of urethroplasty and circumcision were then compared to those of our series.

Patients with EAU had an average stricture length of 3.78 cm (range 2.6 to 5.0) and 10 of 11 procedures (91%) were successful. Anastomotic urethroplasty performed for similar proximal bulbar strictures less than 2.5 cm (mean 1.5, range 1.0 to 2.3) was successful in 10 of 11 cases (91%). Mean followup was 22.1 months and all followups were more than 1 year. Men treated with EAU had no increased rate of stricture recurrence or erectile complaints compared to men in whom shorter proximal bulbar strictures were repaired using an identical surgical technique. Similarly no increased rate of erectile problems was identified compared to other types of urethroplasty and circumcision using an identical questionnaire.

Urethral reconstructability is proportional to the length and elasticity of the distal urethral segment. Defects up to 5 cm may be successfully excised and primarily reconstructed in select young men with proximal bulbar strictures.