Nontransecting modified

1. TRANSECTING TECHNIQUES
• Excision and primary anastomosis
(EPA)
• Augmented anastomotic Urethroplasty
(AAU) (dorsal or ventral graft)

2. Excision and primary anastomosis (EPA)
• The simplest and most effective and durable
surgical treatment for anterior strictures.
• Ideally suited for bulbar strictures
1- to 3-cm long and in some
selected cases up to 5 cm in length.
(Gomez. 2014)

3. EPA Outcome (The gold standard)
• A collection of 12 series from the literature
• More than 1,000 patients
• Long follow up;
• Cure rates ranged from 86 to 98.8 %, with an average of 92 %.

4. EPA –Durable outcome
• EPA offers the best chance for long-term cure of
anterior urethral strictures.
• Andrich et al 2003 reported a 4-fold increase in
stricture recurrence between non-transecting
substitution urethroplasty and EPA.

5. • Yuri and colleagues 2016 in their meta analysis
after an average follow up of 34 months showed
stricture recurrence rates following EPA and BMG
were 8.4% (8/107) and 30% (14/46), respectively.
EPA –Durable outcome

6. Meta analysis EPA
• Morey et al in 2014 SIU/ICUD Consultation on Urethral
Strictures: Anterior Urethra- Primary Anastomosis
• 35-year literature search was conducted (1975-2010) for
peer-reviewed articles on EPA for bulbar strictures.
• 17 articles fulfilled the criteria with a total of 1234 patients.
• Overall success was 93.8%.
• Reported complications were < 5%,
• No evidence of persistent loss of sexual function.
(Morey et al 2014).

7. • Intended for bulbar strictures deemed too long
for straight-forward primary anastomosis.
• This technique saves 1 cm
of urethral shortening
Augmented Anastomotic Urethroplasty (AAU)

8. • Guralnick and Webster 2007 over a mean follow-
up of 28 months, reported 93 % stricture-free
rate.
• Similar results (~90 % success at medium term, 3-
year followup) have been reported by Abouassaly
& Angermeier 2007 and El-Kassaby et al 2008.
Augmented Anastomotic Urethroplasty
(AAU)- OUTCOME

9. • EPA showed Superior results to any other method
of bulbar urethroplasty
(Barbagli et al 2014), (Chapple et al 2014).
Transection Vs non-transection

10. • While attempts to demonstrate equivalency between non-
transecting substitution urethroplasty & transection have
been reported, these studies showed low urethral patency
rates compared to EPA. (Chen, Odom, and Santucci. 2014).
Transection Vs non-transection

11. • Controversial issue with many divergent opinions.
Current data, however, fail to provide clear
evidence of the impact of transection on sexual
function (Barbagli et al 2012)
• Multiple risk factors appear to be involved, such as patient
age, stricture length and location, and type of reconstruction.
Transection and ED

12. • Overall, urethroplasty  transient post-operative
ED in up to 40% of patients.
• While ED in Transection has been shown to be
significantly higher at 3 months, there is no
demonstrable difference at 6 months and beyond
(Erickson et al2007, Coursey et al 2001, Ekerhult et al 2013, El-Assmy et al
2015, Erickson et al 2010, Anger et al 2008 and Blaschko et al 2013)
Transection and ED

13. Transection and ED retrospective
studies

14. Transection and ED prospective studies

15. Transection and ED more prospective
studies

16. Transection and ED Meta analysis

17. Why not non-transecting
• Didn’t remove the fibrotic tissue and recurrence is
inevitable.
• Not suitable for oblitrative and traumatic
stricture.
• Despite initially acceptable urethroplasty outcome
however it is not durable.

18. • Excision of the diseased mucosa only cannot
be compared to full excision of the fibrotic
segment when stricture recurrence rate is
concerned.
Why not non-transecting

19. • Despite theoretical advantage of non
transection over transection regarding erectile
function this was not translated clinically after
6 month so it is better to get a long term cure
of stricture disease instead of being happy with
some earlier return of erection after surgery.
Why not non-transecting

20. THANK YOU
arifmarof@yahoo.com