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. 2023 May 4;33(1):12.
doi: 10.1186/s12610-023-00185-z.

Study on clinical outcomes between non-transecting urethroplasty and lingual mucosal urethroplasty for iatrogenic bulbar urethral stricture treatment

Wei Le #  1 , Denglong Wu  1 , Chengdang Xu #  1 , Weidong Zhou  1 , Chao Li  2
Affiliations

Study on clinical outcomes between non-transecting urethroplasty and lingual mucosal urethroplasty for iatrogenic bulbar urethral stricture treatment

Wei Le et al. Basic Clin Androl. .

Abstract
in English, French

Background: This study aimed to compare the clinical outcomes of non-transecting urethroplasty and lingual mucosal urethroplasty in the treatment of iatrogenic bulbar urethral stricture.

Results: A total of 25 patients with iatrogenic bulbar urethral stricture were enrolled, 12 of whom underwent lingual mucosal urethroplasty, 13 patients who underwent non-transecting urethroplasty. All patients were followed-up and evaluated at 3 postoperative months. Evaluations included urethrography, maximum urine flow rate (Qmax), nocturnal erectile function testing, International Index of Erectile Function (IIEF-5) assessment, and Anxiety Related Scale (SAS) assessment. In terms of operation time, there was a significant difference between non-transecting urethroplasty and lingual mucosal urethroplasty. However, there was no significant intergroup difference in intraoperative blood loss. Both techniques were associated with significantly improved Qmax relative to preoperative rates, but there was no significant difference between the groups in this regard over 3 months of postoperative follow-up. Nocturnal penile tumescence and rigidity results showed that there was no significant change in tip hardness after surgery in the non-transecting urethroplasty group. Moreover, IIEF-5 scores indicated that there was no significant intergroup difference in terms of subjective postoperative erectile function. According to the preliminary psychological evaluations during postoperative follow-up, the anxiety scores of patients undergoing non-transecting urethroplasty significantly improved, but there was no significant change in the mean SAS score among patients who underwent lingual mucosal urethroplasty.

Conclusion: Both surgical methods can achieve the clinical goal of treating iatrogenic bulbar urethral stricture. Non-transecting urethroplasty has the characteristics of short operation time, relative technical simplicity, and retention of the original erectile function of most patients, and the surgical outcomes of non-transecting urethroplasty are not inferior to those of lingual mucosal urethroplasty, and it is a promising technique for widespread use to treat bulbar urethral strictures.

RéSUMé: CONTEXTE: Cette étude visait à comparer les résultats cliniques de l’urétroplastie non transectante et de l’urétroplastie avec greffe de muqueuse linguale dans le traitement de la sténose urétrale bulbaire iatrogène. Un total de 25 patients présentant une sténose urétrale bulbaire iatrogène a été recruté, dont 12 ont subi une urétroplastie avec greffe de muqueuse buccale et 13 une urétroplastie non-transectante. Tous les patients ont été suivis et évalués à 3 mois postopératoires. Les évaluations comprenaient une uréthrographie, le débit urinaire maximal (Qmax), un test nocturne de la fonction érectile, l'évaluation de l'index international de la fonction érectile (IIEF5) et une évaluation de l'échelle d'anxiété. RéSULTATS: En termes de durée opératoire, il y avait une différence significative entre l'urétroplastie non-transectante et urétroplastie avec greffe de muqueuse buccale. Cependant, il n'y avait pas de différence significative entre les groupes en ce qui concerne la perte de sang peropératoire. Les deux techniques ont été associées à une amélioration significative du Qmax par rapport aux taux préopératoires, mais il n'y avait pas de différence significative entre les groupes à cet égard sur 3 mois de suivi postopératoire. Les résultats de la tumescence et de la rigidité nocturnes du pénis ont montré qu'il n'y avait pas de changement significatif de la dureté de l'extrémité du pénis après l'opération dans le groupe d'urétroplastie sans transsection. De plus, les scores IIEF-5 ont indiqué qu'il n'y avait pas de différence significative entre les groupes en termes de fonction érectile subjective postopératoire. Selon les évaluations psychologiques préliminaires au cours du suivi postopératoire, les scores d'anxiété des patients ayant subi une urétroplastie non-transectante se sont améliorés de manière significative, mais il n'y a pas eu de changement significatif du score moyen de l’échelle d’anxiété chez les patients ayant subi une urétroplastie avec greffe de muqueuse buccale. CONCLUSIONS: Les deux méthodes permettent d'atteindre l'objectif clinique du traitement de la sténose urétrale bulbaire iatrogène. L'urétroplastie sans transsection présente les caractéristiques suivantes: temps d'opération court, simplicité technique relative et maintien de la fonction érectile initiale chez la plupart des patients. Les résultats chirurgicaux de l'urétroplastie sans transsection ne sont pas inférieurs à ceux de l’urétroplastie avec greffe de muqueuse buccale et cette technique est prometteuse pour une utilisation généralisée dans le traitement des rétrécissements urétraux bulbaires.

Keywords: Bulbar urethral stricture; Iatrogenic; Non-transecting urethroplasty; Urethral reconstruction.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Preoperative and postoperative urethrography and surgical procedures of the two surgical methods. Bulbar corpus spongiosum non- transecting urethroplasty: A Preoperative urethrography: bulbar urethral stricture; B Dissociate and split the narrow urethra to expose the distal and distal normal urethra mucosa; C 3 − 0 absorbable suture of proximal urethral mucosa and indwelling catheter; D 3 − 0 suture the proximal end of absorbable line with the distal urethral mucosa; E Tighten and tie the distal and distal urethral mucosal sutures; F Postoperative urethrography: the lumen of the bulbar urethra was unobstructed without stenosis lingual mucosal bulbous urethroplasty: G Preoperative urethrography: bulbar urethral stricture; H Dissociate and split the narrow urethra to expose the distal and distal normal urethral mucosa; I The mucous membrane of the tongue was taken and trimmed; J Urethra was dissected and the lingual mucosa Inlay was used to reconstruct the dorsal urethra; K Urethra was dissected and the lingual mucosa Onlay was used to reconstruct the ventral urethra; L Postoperative urethrography: the lumen of the bulbar urethra was unobstructed without stenosis
Fig. 2
Fig. 2
Changes in parameters of maximum postoperative urine flow rate between the two surgical methods. Qmax of the two surgical methods was significantly improved after catheter removal, but there was no significant statistical difference in Qmax parameters between the two groups after catheter removal (NS: compared with the lingual mucosal urethral surgery group, P > 0.05)
Fig. 3
Fig. 3
Comparison of operative time and intraoperative blood loss between the two surgical methods. A Operative time of the two surgical methods. The operative time of lingual mucosa urethroplasty was 135 ± 24.67 min; The operation time of non- transecting urethroplasty was 100.69 ± 14.48 min, and the operation time of non- transecting urethroplasty was shorter, with statistical difference (*: compared with the lingual mucosal urethral surgery group, P < 0.05). B Comparison of intraoperative blood loss between the two surgical methods. Intraoperative blood loss during lingual mucosal urethroplasty was 180 ± 47.16ml, the intraoperative blood loss during non- transecting urethroplasty was 149.2 ± 25.55ml, and there was no statistical difference between the two groups (NS: compared with the lingual mucosal urethral surgery group, P > 0.05)
Fig. 4
Fig. 4
Penile tip hardness values of Post-operative NPTR analysis and IIEF-5 score results between the two surgical methods. A Penile head hardness values of Post-operative NPTR analysis. It showed a downward trend in TIP hardness values of the two different surgical methods, but there was no statistical difference in TIP hardness values of the non- transecting urethra group. There was statistically significant difference in the hardness decrease of the lingual mucosa group, but there was no statistically significant difference in the penile head hardness between the two groups after surgery. B IIEF-5 score results. Follow-up results 3 months after surgery indicated that iIEF-5 value decreased in both the lingual mucosa group and the non- transecting group, and the decrease was statistically significant (P < 0.05). There was no significant difference in IIEF-5 score between the two groups during postoperative follow-up (P > 0.05)
Fig. 5
Fig. 5
Postoperative anxiety psychological evaluation results of the two surgical methods. According to the follow-up of SAS anxiety score, the results showed that the postoperative anxiety SAS score of the non- transecting surgery group significantly decreased; There was no significant difference in the anxiety score of the lingual mucosa surgery group (P > 0.05), although the mean value was decreased. There was no significant difference in SAS score between two groups after operation (P > 0.05)
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