Vessel-sparing Excision and Primary Anastomosis

Area of Science:

• Urology
• Surgical Technique
• Reconstructive Surgery

Background:

• Urethroplasty is the gold standard for urethral strictures, with excision and primary anastomosis (EPA) recommended for short bulbar or posterior strictures.
• Traditional transecting EPA (tEPA) involves full-thickness transection of the corpus spongiosum, which may be unnecessary.
• A vessel-sparing approach (vsEPA) was proposed to minimize surgical trauma and preserve urethral vascularity.

Purpose of the Study:

• To provide a detailed, step-by-step overview of the vessel-sparing excision and primary anastomosis (vsEPA) technique.
• To outline the surgical management of patients with isolated short bulbar or posterior urethral strictures using vsEPA.
• To report the surgical outcomes of the vsEPA technique in a patient cohort.

Main Methods:

• A retrospective analysis of 117 patients undergoing vsEPA for isolated short bulbar or posterior urethral strictures.
• Detailed description of the step-by-step surgical technique for vsEPA.
• Separate analysis of outcomes for bulbar (n=91) and posterior (n=26) stricture groups.

Main Results:

• Overall success rates for vsEPA were high, with 93.4% for the bulbar group and 88.5% for the posterior group.
• The study outlines a protocol for managing specific urethral strictures with vsEPA.
• Low complication rates were observed with the vsEPA technique.

Conclusions:

• Vessel-sparing excision and primary anastomosis (vsEPA) is an effective treatment for isolated short bulbar and posterior urethral strictures.
• The vsEPA technique achieves excellent success rates and low complication rates.
• vsEPA offers potential benefits by reducing surgical trauma compared to traditional methods.