Vessel-sparing Non-transecting Anastomotic Reconstruction of the Posterior Urethra: Single Center Experience with Long-term Follow-up.

Objective: To discuss the long-term results of our vessel-sparing non-transecting approach (vspEPA) to perform anastomotic urethroplasty at the posterior urethra. We avoid transecting the bulbar arteries to preserve the antegrade vascularization of the urethra. We hypothesize that vspEPA is feasible, safe, and not inferior to the traditional transecting technique. Additionally, it may provide benefits if an artificial urinary sphincter (AUS) implantation be required in the future.

Methods: The bulbar urethra was elevated from the corpus cavernosum, released distally, retracted laterally, and approached dorsally at the bulbo-membranous junction. This exposure allows removal of the scar and performs the anastomotic reconstruction as in the standard transecting technique, while avoiding division of the bulbar arteries.

Results: One hundred twenty-seven patients, median age 58 years (interquartile range [IQR] 35-67), were reconstructed since 2008. Etiology of the stenosis was BPH surgery (n = 48), pelvic fracture urethral injury (PFUI) (n = 61), prostate cancer treatment (n = 14) and instrumentation (n = 4). With a median follow-up of 43 months (IQR 17-74) stenosis repair success was observed in 121 patients (95%). High-grade complications (Clavien ≥III) occurred in 6 (5%) of cases and overall stress incontinence was observed in 24 (19%) of patients. Fourteen patients subsequently received an AUS and notably none of them suffered cuff erosion after a median follow-up of 36 months.

Conclusion: Sparing of the bulbar arteries during anastomotic reconstruction of the posterior urethra is feasible and safe. Although slightly more elaborated, it will not compromise the surgical results and may be instrumental to avoid AUS cuff-related erosion in the future.