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A simplified and unified approach to anterior urethroplasty

Nature Reviews Urology volume 7, pages 386–391 (2010)Cite this article

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Abstract

The management of patients with urethral stricture can be a complex process. However, with the appropriate tools, the urologist experienced in urethral surgery can manage most cases without too much difficulty. Here, we describe three surgical techniques—anastomotic urethroplasty, buccal mucosal graft-onlay urethroplasty and the two-staged Johanson urethroplasty—that, in our experience, can accommodate the majority of patients with urethral stricture and provide excellent long-term results. Diagnosis and evaluation of candidacy for each of the surgical techniques are important aspects of treatment planning, and are also described. The aim of the article is to increase the awareness of the technique and application of these three urethroplasty procedures, which can be implemented by all urologists who actively care for and surgically treat patients with urethral stricture disease.

Key Points

  • Urethral stricture disease is a common entity, with an estimated cost of $200 million in the USA

  • Three surgical techniques—anastomotic urethroplasty, buccal mucosal graft-onlay urethroplasty and the two-staged Johanson urethroplasty—can accommodate most patients and yield good long-term results

  • The choice of technique depends on the presenting features of the stricture; therefore, patient selection and candidacy are of paramount importance

  • These surgical techniques can be incorporated into general urologic practice without extensive additional training

  • In respect to long-term recurrence rates, patients are served best by definitive stricture repair rather than palliative procedures, such as dilatation, and direct visualization internal urethrotomy

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Figure 1: The longitudinal success rate for different management approaches in patients with urethral stricture.4,30
Figure 2: Anastomotic urethroplasty.
Figure 3
Figure 4: Two-staged Johanson urethroplasty.
Figure 5: Use of buccal mucosal graft (BMG) onlay during Johanson urethroplasty.

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Authors and Affiliations

  1. The Center for Urologic Reconstruction, Detroit Medical Center, Harper Professional Building, Suite 1017, 4160 John R Street, Detroit, 48201, MI, USA

    W. Britt Zimmerman & Richard A. Santucci

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  1. W. Britt Zimmerman
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  2. Richard A. Santucci
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Correspondence to Richard A. Santucci.

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The authors declare no competing financial interests.

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Zimmerman, W., Santucci, R. A simplified and unified approach to anterior urethroplasty. Nat Rev Urol 7, 386–391 (2010). https://doi.org/10.1038/nrurol.2010.79

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