Extended Primary Anastomosis With Penile Plication (EPAPP): A Promising New Alternative to Perineal Urethrostomy for Reconstruction of Long Urethral Strictures

Maia E. VanDyke, Adam S. Baumgarten, Nicolas M. Ortiz, Benjamin M. Dropkin, Gregory A. Joice, Roger K. Khouri, Joao E.Pinto Filho, Ellen E. Ward, Steven J. Hudak, Allen F. Morey

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: At present, excision and primary anastomosis (EPA) urethroplasty is a highly reliable method of reconstruction for short bulbar urethral strictures. Longer strictures are often managed with grafting techniques to ensure a tension-free repair. Here we report our initial experience with a new, extended anastomotic technique for long bulbar strictures that incorporates plication of the ventral corporal bodies to reduce the distance between the urethral ends and obviates the need for grafting. Methods: We reviewed records for all urethroplasties performed by a single surgeon at our institution between January 2018 and February 2020. We identified a cohort of older patients with complex strictures who underwent Extended Primary Anastomosis with Penile Plication (EPAPP). Patient demographics, stricture characteristics, perioperative 75 parameters, and postoperative outcomes were evaluated. Results: Of 346 urethroplasty records reviewed, 10 patients (2.9%) underwent EPAPP. Mean stricture length was 3.75 ± 1.4 cm. EPAPP patients were older than those repaired by other techniques (mean age 66.6 vs 55.6, P = .024), and most were not sexually active preoperatively. Postoperative voiding cystourethrogram confirmed urethral patency without extravasation in all patients. At a median follow up of 9.7 months (IQR 8.5-11.5) 8 patients remained asymptomatic after EPAPP alone and 2 patients required a single balloon dilation for stricture recurrence. Conclusion: EPAPP is a promising alternative option for the management of long bulbar strictures among appropriately selected patients.

Original languageEnglish (US)
Pages (from-to)245-250
Number of pages6
JournalUrology
Volume149
DOIs
StatePublished - Mar 2021
Externally publishedYes

ASJC Scopus subject areas

  • Urology

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