The impact of muscle-nerve sparring technique on the incidence and severity of post-void dribbling after bulbar urethroplasty

Khlebnikova T.M., Gazimiev M.-S.A., Butnaru D.V., Demidko Yu.L.

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia

Aim. To compare outcome of muscle and nerve-sparing bulbar urethroplasty with standard bulbar urethroplasty as regard frequency and severity of postvoid dribbling.
Materials and methods. Our study included 32 patients with bulbar urethral stricture underwent buccal mucosa graft urethroplasty. 18 patients were operated by dorsal onlay urethroplasty (Barbagi technique), 9 patients underwent ventral onlay urethroplasty, 3 patients were operated by Asopa technique and 2 patients underwent urethroplasty by Kulkarni technique. 19 patients were operated by muscle and nerve-sparing bulbar urethroplasty, 13 patients underwent standard bulbar urethroplasty. Follow-up examination of frequency and severity of urinary disorders were matched by questionnaire at 4 mo, 8 mo and 12 mo after surgery.
Results. Postvoid dribbling was demonstrated in 12 patients (37,5%) at 4 mo after surgery. No statistically significant difference of postvoid dribbling was found between the groups of muscle and nerve-sparing and standard bulbar urethroplasty at 4 mo after surgery (р=0,4104). Postvoid dribbling was demonstrated in 6 patients (18,8%) at 8 mo after surgery: in 2 patients who underwent muscle and nerve-sparing bulbar urethroplasty and in 4 patients who underwent standard bulbar urethroplasty. Postvoid dribbling was demonstrated in 4 patients (12,5%) at 12 mo after surgery: in 1 patients (3,1%) who underwent muscle and nerve-sparing bulbar urethroplasty and in 3 patients (9,4%) who underwent standard bulbar urethroplasty.
Discussion. The frequency of postvoid dribbling is lower in patients with muscle and nerve-sparing bulbar urethroplasty compare to standard bulbar urethroplasty, but no statistically significant difference was found between the groups. Sparing the bulbospongiosus muscle during urethroplasty impact on complete emptying of the urethra. The same time the compensatory capabilities of bulbospongiosus musle in patients who underwent non sparing bulbar urethroplasty impact also on complete emptying of the urethra.
Conclusion. Sparing the bulbospongiosus muscle, the central tendon of the perineum, and the perineal nerves during bulbar urethroplasty seem to have a significant impact on improving outcomes. In our experience the muscle and nerve sparing technique seems to be a safe and effective alternative for standard bulbar urethroplasty on follow-up up to 12 mo.

Keywords

About the Authors

Corresponding author: T.M. Khlebnikova – junior researcher of the Institut for urology and reproductive health Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia, e-mail: khlebnikova.tm@mail.ru

Similar Articles