To present a surgical modification for the repair of bulbar urethral strictures containing short, highly obliterative segments and report on long-term objective and patient-reported outcomes.
We considered patients undergoing bulbar buccal mucosal graft urethroplasty between 07/2016-12/2019. Eligibility criteria for Mucomucosal Anastomotic Non-Transecting Augmentation (MANTA) urethroplasty were strictures ≥2cm with an obliterative segment ≤15mm. The stricture is approached ventrally to avoid extensive dissection and mobilization. Dorsally, the scar is superficially excised, the spongiosum is left intact. Dorsal mucomucosal anastomosis is complemented by ventral onlay graft. Perioperative characteristics were prospectively collected including uroflowmetry data and validated PROMs on voiding, erectile, and continence function. We evaluated functional follow-up, incorporating patient-reported (LUTS score) and functional success. Recurrence was defined as need of retreatment.
Of 641 men treated with anterior BMGU, 54 (8.4%) underwent MANTA urethroplasty. Overall, 26 (48%) and 45 (83%) had a hx of dilation and urethrotomy, respectively, and 14 (26%) were redo cases. Location was bulbar in 38 (70%) and penobulbar in 16 patients (30%) and mean graft length was 45±14mm. At a median follow-up of 41 months (IQR 27-53), functional success was 93%. Whereas the median LUTS score significantly improved from baseline to postoperative (13 vs. 3.5; p<0.001), there was no change in erectile function (median IIEF-EF 27 vs. 24) or urinary continence (median ICIQ-UI SF sum score 0 vs. 0; all p≥0.4). All patients were "satisfied" (27%) or "very satisfied" (73%) with the outcome of their operation.
With excellent long-term objective and patient-reported outcomes, MANTA urethroplasty adds to the armamentarium for long bulbar strictures with a short obliterative segment.
BJU international. 2023 Jul 06 [Epub ahead of print]
Phillip Marks, Roland Dahlem, Florian Janisch, Jakob Klemm, Lennart Kühnke, Frederik König, Liucheng Ding, Silke Riechardt, Margit Fisch, Malte W Vetterlein
Department of Urology, University Medical Center Hamburg Eppendorf, Hamburg, Germany.