Endoscopic treatment for bulbar-membranous urethral obliteration: evaluation of the efficacy and safety

Introduction. The problem of endoscopic treatment for urethral strictures and obliterations remains unresolved. It is necessary to note that the effectiveness depends not only on the right indications, but also on the surgical technique and the study of the postoperative period management.

Objective. To evaluate the efficacy and safety of endoscopic treatment of patients with bulbar-membranous urethral obliteration.

Materials and methods. The study included 103 patients aged 20 to 89 years with bulbar-membrane urethral obliteration, who, for some reason or another, cannot perform urethroplasty. The patients underwent endoscopic recanalization of the urethra under X-ray control with further circular transurethral electroresection (TUR) of the scar tissues in the urethral obliteration zone (after 6 – 7 days).

Results. The average age of the patients was 61.1 ± 18.3 years. After the operation, self-urination was restored in all patients. The average maximum urine flow rate (Q max) before discharge from the hospital was 12.6 ± 0.5 ml/s. Throughout the follow-up period, Q max tended to increase and at the end of the study (36 months) reached values of 16.5 ± 0.5 ml/s. During the first year of follow-up, 18 (17.5%) patients developed recurrent urethral stricture. Seventeen (16.5%) patients underwent repeated circular TUR of scar tissue in the zone of recurrent stricture. The effectiveness of the treatment was 90.0%.

Conclusion. Endoscopic urethral recanalization followed by TUR of scar tissue in the obliteration zone is an effective and safe method in the treatment of bulbar-membranous urethral obliteration with length less than 1.0 cm.

1. Verla W, Oosterlinck W, Spinoit AF, Waterloos M. A Comprehensive Review Emphasizing Anatomy, Etiology, Diagnosis, and Treatment of Male Urethral Stricture Disease. Biomed Res Int. 2019;2019:9046430. https://doi.org/10.1155/2019/9046430

2. Smith TG 3rd. Current management of urethral stricture disease. Indian J Urol. 2016 Jan-Mar;32(1):27-33. https://doi.org/10.4103/0970-1591.173108

3. Sukumar S, Elliott SP, Myers JB, Voelzke BB, Smith TG 3rd, Carolan AMC, Maidaa M, Vanni AJ, Breyer BN, Erickson BA. Multi-Institutional Outcomes of Endoscopic Management of Stricture Recurrence after Bulbar Urethroplasty. J Urol. 2018t;200(4):837-842. https://doi.org/10.1016/j.juro.2018.04.081

4. Baradaran N, Fergus KB, Moses RA, Patel DP, Gaither TW, Voelzke BB, Smith TG 3rd, Erickson BA, Elliott SP, Alsikafi NF, Vanni AJ, Buckley J, Zhao LC, Myers JB, Breyer BN. Clinical significance of cystoscopic urethral stricture recurrence after anterior urethroplasty: a multi-institution analysis from Trauma and Urologic Reconstructive Network of Surgeons (TURNS). World J Urol. 2019;37(12):2763-2768. https://doi.org/10.1007/s00345-019-02653-6

5. Neĭkov K, Panchev P, Kirilov S. Endoskopsko lechenie na pŭlnata obliteratsiia na zadnata uretra [Endoscopic treatment of complete obliteration of posterior urethra]. Khirurgiia (Sofiia). 2001;57(3-4):38-40. (In Bulgarian). PMID: 12024672

6. Trapeznikova M.F., Bazaev V.V., Urenkov S.B. A comparative analysis of the results of open endoscopic operations in posterior urethra obliterations in men. Urologiia. 2004;(1):47-54.(In Russ.) EDN:OKLDOH

7. MartovA.G., GuschinB. L, Merinov D.S., Ergakov D.V., Pavlov D.A., Shekhovtsov S. Yu., Karaguzhin S.G., Lisenok A.A. Endoscopic and roentgenoendoscopic technologies in urology. Urologiia. 2004;(1):54-57. (In Russ.) EDN:OKLDOR

8. Lozano JL, Arruza A. Substitution urethroplasty. Long term follow up results in a group of 50 patients. Arch Esp Urol. 2015;68(4):424-8. (English, Spanish) PMID: 26033762

9. Martov A.G., Ergakov D.V., Salyukov R.V., Fakhredinov G.A. Long-term results of endoscopic treatment of urethral strictures. Urologiia. 2007;(5):27-32. (In Russ.) EDN:ICEJKB

10. Latini JM, McAninch JW, Brandes SB, Chung JY, Rosenstein D. SIU/ICUD Consultation On Urethral Strictures: Epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral disruption injuries. Urology. 2014;83(3 Suppl):S1-7. https://doi.org/10.1016/j.urology.2013.09.009

11. Takeuchi T, Ishihara S, Nagatani Y, Koide T, Sakai S, Tamaki M, Maeda S, Yamamoto N, Kobayashi S, Kawada Y. [Endourological re-establishment by transluminal puncture for a complete obliteration of traumatic urethral disruption]. Nihon Hinyokika Gakkai Zasshi. 1991;82(5):750-7. (In Japanese) https://doi.org/10.5980/jpnjurol1989.82.750

12. Aoki D, Koga S, Shono T, Kanetake H, Matsuya F, Hirashima S, Shindo K, Hayashi M. Simultaneous two-plane x-ray imaging for endoscopic recanalization of prostatomembranous urethral disruption. Urology. 2002;60(5):899-901. https://doi.org/10.1016/s0090-4295(02)01854-x