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Updated: Nov 17, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Ventral Approach for the Non-transecting Bulbar Urethroplasty
E Morán1, I Sáez Moreno1, M A Bonillo1
1La Fe University Hospital, Valencia.
Background:
Nowadays, short bulbar strictures refractory to one endoscopic treatment attempt could be managed with non-transecting urethroplasty technique as a first option.1 Jordan et al2 and Bugeja et al3 described a dorsal approach, sparing vessels, and spongiosum in the hope of a decrease of surgical side effects.
Objective:
To describe the step-by-step technique of the ventral approach for the non-transecting bulbar urethroplasty in distal and mid short bulbar strictures.
Materials And Methods:
We performed a prospective observational study of a cohort of patients who underwent a ventral non-transecting bulbar urethroplasty for short mid or distal bulbar strictures from January 2016 to December 2018. We included 10 patients.
Surgical Technique:
A ventral midline urethrotomy is made and extended to assure a good caliber lumen both distally and proximally (20 Fr). The mucosal scar tissue is marked and a mucosectomy is performed, preserving the spongiosum.We bring the distal and proximal edges of healthy mucosa together without tension with a 5/0 absorbable monofilament. Ventral stricturotomy is closed over a 20F catheter, in a Heinike-Mikulics fashion, with 5/0 absorbable monofilament for the mucosal anastomosis and a 4/0 absorbable monofilament for the spongioplasty.
Results:
Mean age was 56,50 years (+/-17,27) and mean stricture length was 1,06cm (+/-1,82). The majority of strictures (90%) were located in the mid bulb. After a mean follow up of 27,25 months (+/-12,12), 9 patients remain recurrence-free (87,5%). A significant mean increase in Qmax was observed (12+/-4,53 ml/s, p=0,04). Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROMS), items (Questions 1-6) related to urinate symptoms also showed a significant improvement(p=0,03). We didn't find any significant decrease in erectile function with this technique.
Conclusion:
The ventral approach for mid and distal short bulbar strictures is a feasible and reproducible technique with a significant increase in Qmax and improvement in USS-PROMS. Preliminary results show no decrease in erectile function.
