Histotopographic Reasons for Ventral Approach in Bulbous Non-Transecting Urethroplasty.

Abstract

Objective: A histotopographic research study was performed to justify the ventral approach for nontransecting anastomotic bulbar urethroplasty. Methods: The study included 10 preparations of the male penis, including the bulbous sections of the urethra with no signs of structural damage. The material was obtained during autopsy from men aged 36-60 years old. The features of the blood supply and innervation of the bulbous urethra were carefully examined, revealing the advantages of the proposed method. Results: The authors obtained data providing sufficient evidence for the safety and histotopographic validity of the ventral approach with preservation of the dorsal and lateral parts of the corpus spongiosum of the urethra. Conclusion: The choice of urethroplasty for bulbous urethral strictures less than 2 cm in length requires in-depth knowledge of the anatomy of the vascular and autonomic nerve fibers of the spongious body of the bulbous urethra, as well as the course of the cavernous nerves along its dorsal semicircle. In carefully selected patients with short (<2 cm in length) strictures of the bulbous urethra without spongiofibrosis, it is possible to avoid anastomotic urethroplasty with total transection of the spongious body by choosing nontransecting excision and primary anastomosis (ntEPA), which allows to preserve innervation and blood supply in the urethra to a greater extent. In this regard, the ventral ntEPA technique seems promising, as it is likely that the neurovascular structures in the urethra are mostly located outside the area of this zone-in the lateral frequent. However, definitive conclusions are possible after further scientific research in this area.