Repair of sphincter urethral strictures preserving urinary continence: surgical technique and outcomes.

Repair of post-TURP sphincter urethral strictures represents challenging problem, due to the risk of urinary incontinence after the repair. We described a surgical technique we use to repair these strictures preserving urinary continence in patients with incompetent bladder neck.

An observational, retrospective, study was conducted to include patients with post-TURP urethral strictures in the area of distal sphincter. We included only patients with complete clinical data and follow-up who previously underwent TURP or HOLEP or TUIP, and subsequently developed proximal bulbar urethral strictures close to the membranous urethra and the related distal urethral sphincter. Patients were included, if they were fully continent after TURP or other procedures to treat BPH. The primary outcome of the study was treatment failure, defined as the need for any post-operative instrumentation. Secondary outcome was post-urethroplasty urinary continence. Patients showing stricture recurrence or post-operative incontinence were classified as failure.

Overall, 69 patients were included in the study. Median patient's age was 67 years; median stricture length was 4 cm. Thirty-tree patients (47.8%) underwent previous urethrotomy. Median follow-up was 52 months. Out of 69 patients, 55 (79.7%) were classified as success and 14 (20.3%) as failure. Out of the whole cohort, thus, 11/69 (16%) have a risk of recurrent strictures and 3/69 (4.3%) have incontinence.

The use of modified ventral onlay graft urethroplasty, using particular non-aggressive steps, is a suitable surgical technique for repair of sphincter urethral stricture in patients who underwent BPH transurethral surgery, using different procedures (TURP, HOLEP, TUIP).

World journal of urology. 2019 Feb 23 [Epub ahead of print]

Guido Barbagli, Sanjay B Kulkarni, Pankaj M Joshi, Dmitriy Nikolavsky, Francesco Montorsi, Salvatore Sansalone, Carla Loreto, Massimo Lazzeri

Centro Chirurgico Toscano, Arezzo, Italy., Kulkarni Reconstructive Urology Center, Pune, India., Departments of Urology and Pathology, Syracuse, State University of New York Upstate Medical University, New York, USA., Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy., Department of Experimental Medicine and Surgery, University of Tor Vergata, Rome, Italy., Department of Biomedical and Biotechnological Sciences, Section of Anatomy and Histology, University of Catania, Catania, Italy., Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital (ML), Rozzano, Italy. .