Vessel and Muscle Sparing Techniques in Bulbous Urethroplasty: A Review

Excision and primary anastomosis has emerged as a standard of care for urethral strictures in men with satisfactory results for urethral patency. Several improvements, particularly in repair of proximal bulbous strictures, aim to preserve the vascular pedicle and avoid violating the bulbospongiosus muscle and its innervation during perineal access to the urethra. For patients with anterior urethral strictures these techniques may offer benefits such as decreased sexual dysfunction, post-void dribbling and ejaculatory changes. We describe techniques for and potential functional effects of bulbar artery sparing and bulbospongiosus muscle sparing excision and primary anastomosis, as well as pertinent anatomical principles.

We searched PubMed® and Web of Science™ for relevant articles using the keywords "urethroplasty," "urethral reconstruction," "anterior," "bulbous," "vessel sparing," "muscle sparing," "non-transecting," "bulbar artery" and "bulbospongiosus." Two authors independently screened results, and articles not relevant or not written in English were excluded.

Preservation of proximal urethral blood supply is imperative, particularly for patients with multiple prior urethral reconstructions, hypospadias or potential need for artificial sphincter for incontinence (eg after prostatectomy). Since vessel sparing excision and primary anastomosis was first described, there have been several modifications with promising outcomes. In the same context bulbospongiosus muscle sparing urethroplasty has been described and is associated with favorable outcomes for post-void dribbling and ejaculatory dysfunction.

Preservation of vessels, nerves and muscles around the urethra is associated with favorable functional outcomes. Short-term results are reassuring, although longer followup and more uniform criteria for measuring patient reported outcomes are needed.