Monday, April 16, 2012

The Augmented Nontransected Anastomotic Urethroplasty for the Treatment of Bulbar Urethral Strictures

Figure 1. Intraoperative pictures of an ANTA urethroplasty. (1) Bulbar urethra after dorsal urethrotomy. Narrowest portion of the stricture marked with purple ink. (2) Incision through the mucosa. (3) Resection of the diseased mucosa and spongiosum. (4) Reanastomosis of the mucosa corners with 4-0 sutures (a) and then closure of the redundant urethral serosa with 5-0 Glycomer sutures (b). (5) Closure of the mucosa defect with 5-0 sutures (a) and 4-0 (b) Glycomer sutures.

The ANTA is a viable option for treatment of bulbar
urethral strictures. This technique allows the surgeon to
(1) avoid urethral transection, (2) reconfigure the width
of the urethral plate, and (3) use a smaller buccal graft
compared with a traditional DOBG. It compares favorably
with other urethroplasty series and to our DOBG
patients in terms of complications and outcomes. We feel
it is an appropriate option for bulbar strictures that are
both too long for excision and primary reanastomosis,
and that have a focal area of obliteration that does not
extend through the full thickness of the spongiosum.



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