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Complications of urethral surgery

https://doi.org/10.21886/2308-6424-2025-13-2-69-78

Abstract

Reconstructive urology encompasses a diverse array of surgical modalities for the management of urethral strictures in the male population. Despite the extensive documentation of various surgical approaches and their purported benefits in the existing literature, there remains a notable paucity of comprehensive data regarding intraoperative and postoperative complications. These adverse events unequivocally exert a significant impact on patients’ quality of life and overall treatment satisfaction. The present manuscript provides a systematic review of the international literature pertaining to potential complications associated with diverse therapeutic interventions for urethral stricture disease.

About the Authors

B. R. Gvasalia
Russian University of Medicine ; Botkin City Clinical Hospital
Russian Federation

Badri R. Gvasalia — Dr.Sc.(Med), Full Prof. 

Moscow 


Competing Interests:

The authors declare no conflicts of interest. 



M. U. Babaev
Russian University of Medicine
Russian Federation

Mikhail U. Babaev 

Moscow 


Competing Interests:

The authors declare no conflicts of interest. 



A. V. Isaeva
Russian University of Medicine
Russian Federation

Anna V. Isaevа 

Moscow 


Competing Interests:

The authors declare no conflicts of interest. 



A. B. Bogdanov
Botkin City Clinical Hospital ; Russian Medical Academy of Continuous Professional Education
Russian Federation

Andrey B. Bogdanov — Cand.Sc.(Med), Assoc. Prof. (Docent) 

Moscow 


Competing Interests:

The authors declare no conflicts of interest. 



Yu. P. Gorobets
Russian University of Medicine
Russian Federation

Yuri P. Gorobets 

Moscow 


Competing Interests:

The authors declare no conflicts of interest. 



D. A. Chesnov
Russian University of Medicine
Russian Federation

Dmitriy A. Chesnov 

Moscow 


Competing Interests:

The authors declare no conflicts of interest. 



References

1. Wessells H, Angermeier KW, Elliott S, Gonzalez CM, Kodama R, Peterson AC, Reston J, Rourke K, Stoffel JT, Vanni AJ, Voelzke BB, Zhao L, Santucci RA. Male Urethral Stricture: American Urological Association Guideline. J Urol. 2017;197(1):182-190. DOI: 10.1016/j.juro.2016.07.087

2. Palminteri E, Berdondini E, Verze P, De Nunzio C, Vitarelli A, Carmignani L. Contemporary urethral stricture characteristics in the developed world. Urology. 2013;81(1):191-196. DOI: 10.1016/j.urology.2012.08.062

3. Bayne DB, Gaither TW, Awad MA, Murphy GP, Osterberg EC, Breyer BN. Guidelines of guidelines: a review of urethral stricture evaluation, management, and follow-up. Transl Androl Urol. 2017;6(2):288-294. DOI: 10.21037/tau.2017.03.55

4. Buckley JC, Heyns C, Gilling P, Carney J. SIU/ICUD Consultation on Urethral Strictures: Dilation, internal urethrotomy, and stenting of male anterior urethral strictures. Urology. 2014;83(3 Suppl):S18-22. DOI: 10.1016/j.urology.2013.08.075

5. Wessells H, Morey A, Souter L, Rahimi L, Vanni A. Urethral Stricture Disease Guideline Amendment (2023). J Urol. 2023;210(1):64-71. DOI: 10.1097/JU.0000000000003482

6. Barbagli G, Fossati N, Montorsi F, Balò S, Rimondi C, Larcher A, Sansalone S, Butnaru D, Lazzeri M. Focus on Internal Urethrotomy as Primary Treatment for Untreated Bulbar Urethral Strictures: Results from a Multivariable Analysis. Eur Urol Focus. 2020;6(1):164-169. DOI: 10.1016/j.euf.2018.10.014

7. Pal DK, Kumar S, Ghosh B. Direct visual internal urethrotomy: Is it a durable treatment option? Urol Ann. 2017;9(1):18-22. DOI: 10.4103/0974-7796.198835

8. Martov A.G., Fakhrredinov G.A., Maksimov V.A., Kornienko S.I., Ergakov D.V. Complications and Failures of Transurethral Operations on the Urinary Tract. Vestnik of the Russian scientific center of roentgenoradiology. 2011;(11-2):18. (In Russian). eLIBRARY ID: 17088670; EDN: OJYSZJ

9. Medvedev V.L., Medoev Y.N., Mitusov V.V. The minimally invasive methods of treatment of anterior urethra strictures. Urology Herald. 2017;5(2):69-76. (In Russian). DOI: 10.21886/2308-6424-2017-5-2-69-76

10. Sedigh O, Dalmasso E, Gobbo A, Dashti MH, Bagheri F, Shamsodini A, Alqattan Y, Soleimanzadeh F, Buffi NM, Gontero P, Hosseini J. Feasibility and Outcomes of Temporary Bulbar Urethral Stent Placement After Internal Urethrotomy in the Largest Multicenter Series. Eur Urol. 2023 Sep;84(3):313-320. DOI: 10.1016/j.eururo.2023.05.019

11. Pavlov V.N., Kazikhinurov R.A., Kazikhinurov A.A., Safiullin R.I., Pushkarev A.M., Zagitov A.R., Farganov A.R., Biganyakov I.I. The result of surgical treatment improvement for patients with posttraumatic, inflamatory and obstructive strictures of urethra. Medical Bulletin of Bashkortostan. 2020;15(5):9-12. (In Russian.). eLIBRARY ID: 44751883; EDN: MAHBUP

12. Glukhov V.P., Ilyash A.V., Mitusov V.V., Kubasov D.O., Pilieva A.V., Khoronko Yu.V., Kogan M.I. Relapses of urethral strictures associated with a pelvic ring fracture and osteosynthesis: the features of treatment and prevention. Urology Herald. 2021;9(2):25-33. (In Russian). DOI: 10.21886/2308-6424-2021-9-2-25-33

13. Mouraviev VB, Coburn M, Santucci RA. The treatment of posterior urethral disruption associated with pelvic fractures: comparative experience of early realignment versus delayed urethroplasty. J Urol. 2005;173(3):873-876. DOI: 10.1097/01.ju.0000152145.33215.36

14. Morey AF, Kizer WS. Proximal bulbar urethroplasty via extended anastomotic approach--what are the limits? J Urol. 2006;175(6):2145-2149; discussion 2149. DOI: 10.1016/S0022-5347(06)00259-X

15. Lumen N, Hoebeke P, Troyer BD, Ysebaert B, Oosterlinck W. Perineal anastomotic urethroplasty for posttraumatic urethral stricture with or without previous urethral manipulations: a review of 61 cases with long-term followup. J Urol. 2009;181(3):1196-1200. DOI: 10.1016/j.juro.2008.10.170

16. Guan Y, Wendong S, Zhao S, Liu T, Liu Y, Zhang X, Yuan M. The vascular and neurogenic factors associated with erectile dysfunction in patients after pelvic fractures. Int Braz J Urol. 2015;41(5):959-966. DOI: 10.1590/S1677-5538.IBJU.2014.0170

17. Koraitim MM. Predictors of erectile dysfunction post pelvic fracture urethral injuries: a multivariate analysis. Urology. 2013;81(5):1081- 1085. DOI: 10.1016/j.urology.2012.12.040

18. Johnsen NV, Moses RA, Elliott SP, Vanni AJ, Baradaran N, Greear G, Smith TG 3rd, Granieri MA, Alsikafi NF, Erickson BA, Myers JB, Breyer BN, Buckley JC, Zhao LC, Voelzke BB; Trauma Urologic Reconstruction Network of Surgeons(TURNS). Multicenter analysis of posterior urethroplasty complexity and outcomes following pelvic fracture urethral injury. World J Urol. 2020;38(4):1073-1079. DOI: 10.1007/s00345-019-02824-5

19. Corriere JN. 1-Stage delayed bulboprostatic anastomotic repair of posterior urethral rupture: 60 patients with 1-year followup. J Urol. 2001;165(2):404-407. DOI: 10.1097/00005392-200102000-00012

20. Andrich DE, Mundy AR. Urethral strictures and their surgical treatment. BJU Int. 2000;86(5):571-580. DOI: 10.1046/j.1464-410x.2000.00878.x

21. Andrich DE, Mundy AR. What is the best technique for urethroplasty? Eur Urol. 2008;54(5):1031-1041. DOI: 10.1016/j.eururo.2008.07.052

22. Barbagli G, De Angelis M, Romano G, Lazzeri M. Long-term followup of bulbar end-to-end anastomosis: a retrospective analysis of 153 patients in a single center experience. J Urol. 2007;178(6):2470-2473. DOI: 10.1016/j.juro.2007.08.018

23. Chapman DW, Cotter K, Johnsen NV, Patel S, Kinnaird A, Erickson BA, Voelzke B, Buckley J, Rourke K. Nontransecting Techniques Reduce Sexual Dysfunction after Anastomotic Bulbar Urethroplasty: Results of a Multi-Institutional Comparative Analysis. J Urol. 2019;201(2):364-370. DOI: 10.1016/j.juro.2018.09.051

24. Oszczudlowski M, Yepes C, Dobruch J, Martins FE. Outcomes of transecting versus non-transecting urethroplasty for bulbar urethral stricture: a meta-analysis. BJU Int. 2023;132(3):252-261. DOI: 10.1111/bju.16108

25. Maciejewski CC, Haines T, Rourke KF. Chordee and Penile Shortening Rather Than Voiding Function Are Associated With Patient Dissatisfaction After Urethroplasty. Urology. 2017;103:234-239. DOI: 10.1016/j.urology.2016.12.047

26. Whitson JM, McAninch JW, Elliott SP, Alsikafi NF. Long-term efficacy of distal penile circular fasciocutaneous flaps for single stage reconstruction of complex anterior urethral stricture disease. J Urol. 2008;179(6):2259-2264. DOI: 10.1016/j.juro.2008.01.087

27. Alsagheer GA, Fathi A, Abdel-Kader MS, Hasan AM, Mohamed O, Mahmoud O, Abolyosr A. Management of long segment anterior urethral stricture (≥ 8cm) using buccal mucosal (BM) graft and penile skin (PS) flap: outcome and predictors of failure. Int Braz J Urol. 2018;44(1):163- 171. DOI: 10.1590/S1677-5538.IBJU.2017.0083

28. Hmida W, Othmen MB, Bako A, Jaidane M, Mosbah F. Penile skin flap: a versatile substitute for anterior urethral stricture. Int Braz J Urol. 2019;45(5):1057-1063. DOI: 10.1590/S1677-5538.IBJU.2018.0652

29. Lozano JL, Ruiz S, Fernández R, Gutiérrez G, Iturregui AM, Anton M. 20 años realizando uretroplastias. Revisión retrospectiva y resultados [20 years urethroplasty experience. Retrospective review and outcomes.]. Arch Esp Urol. 2020;73(2):89-95. (In Spanish). PMID: 32124838.

30. Dubey D, Vijjan V, Kapoor R, Srivastava A, Mandhani A, Kumar A, Ansari MS. Dorsal onlay buccal mucosa versus penile skin flap urethroplasty for anterior urethral strictures: results from a randomized prospective trial. J Urol. 2007;178(6):2466-2469. DOI: 10.1016/j.juro.2007.08.010

31. Soliman MG, Abo Farha M, El Abd AS, Abdel Hameed H, El Gamal S. Dorsal onlay urethroplasty using buccal mucosa graft versus penile skin flap for management of long anterior urethral strictures: a prospective randomized study. Scand J Urol. 2014;48(5):466-473. DOI: 10.3109/21681805.2014.888474

32. Tyagi S, Parmar KM, Singh SK, Sharma A, Shukla M, Sharma AP, Devana SK, Sharma G, Kumar S, Mandal AK. ‘Pee’BuSt Trial: A single-centre prospective randomized study comparing functional and anatomic outcomes after augmentation urethroplasty with penile skin graft versus buccal mucosa graft for anterior urethral stricture disease. World J Urol. 2022;40(2):475-481. DOI: 10.1007/s00345-021-03843-x

33. Xu YM, Xu QK, Fu Q, Sa YL, Zhang J, Song LJ, Hu XY, Li C. Oral complications after lingual mucosal graft harvesting for urethroplasty in 110 cases. BJU Int. 2011;108(1):140-145. DOI: 10.1111/j.1464-410X.2010.09852.x

34. Dublin N, Stewart LH. Oral complications after buccal mucosal graft harvest for urethroplasty. BJU Int. 2004;94(6):867-869. DOI: 10.1111/j.1464-410X.2004.05048.x

35. Zimmerman WB, Santucci RA. Buccal mucosa urethroplasty for adult urethral strictures. Indian J Urol. 2011;27(3):364-370. DOI: 10.4103/0970-1591.85441

36. Shcheplev P.A., Gvasalia B.R., Garin N.N., Krutykh A.A. Complications of taking a graft of the oral mucosa during urethroplasty. Andrology and genital surgery. 2009;(2):166. (In Russian). eLIBRARY ID: 12838274; EDN: KUYLHR

37. Soave A, Dahlem R, Pinnschmidt HO, Rink M, Langetepe J, Engel O, Kluth LA, Loechelt B, Reiss P, Ahyai SA, Fisch M. Substitution Urethroplasty with Closure Versus Nonclosure of the Buccal Mucosa Graft Harvest Site: A Randomized Controlled Trial with a Detailed Analysis of Oral Pain and Morbidity. Eur Urol. 2018;73(6):910-922. DOI: 10.1016/j.eururo.2017.11.014

38. Akpayak IC, Shuaibu SI, Ofoha CG, Oshagbemi AO, Dakum NK, Ramyil VM. Dorsal onlay buccal mucosa graft urethroplasty for bulbar urethral stricture: a single centre experience. Pan Afr Med J. 2020;36:305. DOI: 10.11604/pamj.2020.36.305.21398

39. Furr JR, Wisenbaugh ES, Gelman J. Long-term outcomes for 2-stage urethroplasty: an analysis of risk factors for urethral stricture recurrence. World J Urol. 2021;39(10):3903-3911. DOI: 10.1007/s00345-021-03676-8

40. Spilotros M, Sihra N, Malde S, Pakzad MH, Hamid R, Ockrim JL, Greenwell TJ. Buccal mucosal graft urethroplasty in men-risk factors for recurrence and complications: a third referral centre experience in anterior urethroplasty using buccal mucosal graft. Transl Androl Urol. 2017;6(3):510-516. DOI: 10.21037/tau.2017.03.69

41. Mertziotis N, Konandreas A, Kyratsas C. Combined Dorsal and Ventral Onlay Buccal Graft Technique for Large and Complex Penile Strictures. Adv Urol. 2018;2018:1846060. DOI: 10.1155/2018/1846060

42. Gvasalia B.R. Reconstructive surgery of the urethra [dissertation]. Moscow; 2012. (In Russian). Accessed December 03, 2024. URL: https://medical-diss.com/medicina/rekonstruktivnaya-hirurgiyauretry-1

43. Jasionowska S, Brunckhorst O, Rees RW, Muneer A, Ahmed K. Redo-urethroplasty for the management of recurrent urethral strictures in males: a systematic review. World J Urol. 2019;37(9):1801-1815. DOI: 10.1007/s00345-019-02709-7

44. Wong SS, Aboumarzouk OM, Narahari R, O’Riordan A, Pickard R. Simple urethral dilatation, endoscopic urethrotomy, and urethroplasty for urethral stricture disease in adult men. Cochrane Database Syst Rev. 2012;12(12):CD006934. DOI: 10.1002/14651858.CD006934.pub3

45. Claassen FM, Mutambirwa SBA, Potgieter L, Botes L, Kotze HF, Smit FE. Outcome determinants of urethroplasty in the management of inflammatory anterior urethral strictures. S Afr Med J. 2019;109(12):947-951. DOI: 10.7196/SAMJ.2019.v109i12.14003

46. Kogan M.I., Glukhov V.P., Ilyash A.V., Mitusov V.V., Chibichyan M.B. Complex spongy urethral strictures with multistage treatment: predicting the recurrence risk. Experimental and Clinical Urology. 2022;15(1):136- 141. (In Russian). DOI: 10.29188/2222-8543-2022-15-1-136-141

47. Kogan M.I., Glukhov V.P., Ilyash A.V., Bugaenko V.A., Mitusov V.V., Sizyakin D.V. Multi-stage operations for anterior urethral strictures: evaluation of sexual function. Experimental and Clinical Urology. 2022;15(4):96-101. (In Russian). DOI: 10.29188/2222-8543-2022-15-4-96-101

48. Xie H, Xu YM, Fu Q, Sa YL, Qiao Y. The relationship between erectile function and complex panurethral stricture: a preliminary investigative and descriptive study. Asian J Androl. 2015;17(2):315-318. DOI: 10.4103/1008-682X.143312

49. Blaschko SD, Sanford MT, Cinman NM, McAninch JW, Breyer BN. De novo erectile dysfunction after anterior urethroplasty: a systematic review and meta-analysis. BJU Int. 2013;112(5):655-663. DOI: 10.1111/j.1464-410X.2012.11741.x

50. Blakely S, Caza T, Landas S, Nikolavsky D. Dorsal Onlay Urethroplasty for Membranous Urethral Strictures: Urinary and Erectile Functional Outcomes. J Urol. 2016;195(5):1501-1507. DOI: 10.1016/j.juro.2015.11.028

51. Sachin D, ChikkaMoga Siddaiah M, Vilvapathy Senguttuvan K, Chandrashekar Sidaramappa R, Ramaiah K. Incidence of De Novo Erectile Dysfunction after Urethroplasty: A Prospective Observational Study. World J Mens Health. 2017;35(2):94-99. DOI: 10.5534/wjmh.2017.35.2.94

52. Rosenbaum CM, Ernst L, Engel O, Dahlem R, Fisch M, Kluth LA. RedoHarnröhrenplastik mit Mundschleimhaut [Redo urethroplasty with buccal mucosa]. Urologe A. 2017;56(10):1274-1281. (In German). DOI: 10.1007/s00120-017-0475-4

53. Chauhan S, Yadav SS, Tomar V. Outcome of buccal mucosa and lingual mucosa graft urethroplasty in the management of urethral strictures: A comparative study. Urol Ann. 2016;8(1):36-41. DOI: 10.4103/0974-7796.165715

54. Palmer DA, Buckley JC, Zinman LN, Vanni AJ. Urethroplasty for high risk, long segment urethral strictures with ventral buccal mucosa graft and gracilis muscle flap. J Urol. 2015;193(3):902-905. DOI: 10.1016/j.juro.2014.09.093

55. Pathak HR, Jain TP, Bhujbal SA, Meshram KR, Gadekar C, Parab S. Does site of buccal mucosa graft for bulbar urethra stricture affect outcome? A comparative analysis of ventral, dorso-lateral and dorsal buccal mucosa graft augmentation urethroplasty. Turk J Urol. 2017;43(3):350-354. DOI: 10.5152/tud.2017.30771

56. Shalkamy O, Abdelazim H, Elshazly A, Soliman A, Agha M, Tagreda I, Hindawy M, Kotb A, Farid M, Ahmed AF. Factors Predicting Urethral Stricture Recurrence after Dorsal Onlay Augmented, Buccal Mucosal Graft Urethroplasty. Urol Int. 2021;105(3-4):269-277. DOI: 10.1159/000512065

57. Vasudeva P, Nanda B, Kumar A, Kumar N, Singh H, Kumar R. Dorsal versus ventral onlay buccal mucosal graft urethroplasty for long-segment bulbar urethral stricture: A prospective randomized study. Int J Urol. 2015;22(10):967-971. DOI: 10.1111/iju.12859

58. Akyüz M, Tokuç E, Özsoy E, Koca O, Kanberoğlu H, Öztürk M, Topaktaş R. Characteristics of the urethroplasty and our approach-Experience in patients with urethral stricture. Turk J Urol. 2018;45(4):307-311. DOI: 10.5152/tud.2018.68700

59. Loran O.B., Veliev E.I., Kotov S.V., Belomytsev S.V. Buccal mucosa graft for augmented urethroplasty. The journal of general medicine. 2012;(2):93-98. (In Russian). eLIBRARY ID: 17937721; EDN: PCNUXL

60. Glukhov V.P., Ilyash A.V., Vasilev K.S., Slyusarenko N.V., Ismailov R.S., Mitusov V.V., Sizyakin D.V., Kogan M.I. Multi-stage urethroplasy for anterior urethral strictures: objective parameters of long-term efficacy and patientreported outcomes. Urology Herald. 2022;10(4):21-31. (In Russian). DOI: 10.21886/2308-6424-2022-10-4-21-31

61. Amirbekov B.G., Kogan M.I., Mitusov V.V., Mirzayev Z.A., Kosterov M.V. Quality of life dynamics in men after urethral stricture surgery. Urology Herald. 2019;7(2):5-13. (In Russian). DOI: 10.21886/2308-6424-2019-7-2-5-13


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For citations:


Gvasalia B.R., Babaev M.U., Isaeva A.V., Bogdanov A.B., Gorobets Yu.P., Chesnov D.A. Complications of urethral surgery. Urology Herald. 2025;13(2):69-78. (In Russ.) https://doi.org/10.21886/2308-6424-2025-13-2-69-78

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