The Augmented Anastomotic Urethroplasty

  • Michael L. Guralnick
  • R. Corey O’Connor
Part of the Current Clinical Urology book series (CCU)


Primary anastomotic urethroplasty with complete stricture excision provides for the most successful outcome in bulbar urethral reconstruction. However, there are times when, following stricture excision and urethral spatulation, too much tension would be present for a primary anastomosis. The augmented anastomotic urethroplasty is a combination repair that incorporates the principles of excision and substitution urethroplasty. It is intended for bulbar strictures deemed too long for straightforward primary anastomosis, particularly those with a dense area of scarring and adjacent wider caliber stricture. With this technique, up to 2 or 3 cm of strictured urethra may be excised, followed by reapproximation of either the dorsal or ventral walls. The opposite urethral wall is then closed with an onlay graft. In this chapter, we discuss our graded approach to the management of bulbar strictures and our rationale for utilizing the augmented anastomotic repair and outline our surgical technique.


Tunica Albuginea Strictured Urethra Corporal Body Bulbar Urethra Urethral Wall 
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The authors wish to thank Dr. George Webster, one of the authors of this chapter in the 1st edition, for his guidance, mentoring and friendship. We would also like to acknowledge his invaluable contributions to the art of urethral surgery


  1. 1.
    Turner-Warwick R. Principles of urethral reconstruction. In: Webster G, Kirby R, King L, et al., editors. Reconstructive urology, vol. 2. Boston: Blackwell Scientific; 1993. p. 609–42.Google Scholar
  2. 2.
    Morey AF, Kizer WS. Proximal bulbar urethroplasty via an extended anastomotic approach: what are the limits? J Urol. 2006;175:2145–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Peterson AC, Palminteri E, Lazzeri M, Guazzoni G, Barbagli G, Webster GD. Heroic measures may not always be justified in extensive urethral stricture due to lichen sclerosis (balanitis xerotica obliterans). Urology. 2004;64:565–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Abouassaly R, Angermeier KW. Augmented anastomotic urethroplasty. J Urol. 2007;177:2211–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Dubey D, Vijjan V, Kapoor K, et al. Dorsal onlay buccal mucosa versus penile skin flap urethroplasty for anterior urethral strictures: results from a randomized prospective trial. J Urol. 2007;178:2466–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Kambouri K, Gardikis S, Giatromanolaki A, Efstathiou E, Pitiakoudis M, Ipsilantis P, et al. Comparison of angiogenic activity after urethral reconstruction using free grafts and pedicle flap: an experimental study. Eur J Pediatr Surg. 2006;16:323.PubMedCrossRefGoogle Scholar
  7. 7.
    Barbagli G, Selli C, di Cello V, Mottola A. A one-stage dorsal free-graft urethroplasty for bulbar urethral strictures. Br J Urol. 1996;78:929–32.PubMedCrossRefGoogle Scholar
  8. 8.
    Barbagli G, Palminteri E, Rizzo M. Dorsal onlay graft urethroplasty using penile skin or buccal mucosa in adult bulbourethral strictures. J Urol. 1998;160: 1307–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Pansadoro V, Emiliozzi P, Gaffi M, Scarpone P. Buccal mucosa urethroplasty for the treatment of bulbar urethral strictures. J Urol. 1999;161:1501–3.PubMedCrossRefGoogle Scholar
  10. 10.
    Barbagli G, Palminteri E, Guazzoni G, Montorsi F, Turini D, Lazzeri M. Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique? J Urol. 2005;174:955–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Mangera A, Patterson JM, Chapple CR. A systematic review of graft augmentation urethroplasty techniques for the treatment of anterior urethral strictures. Eur Urol. 2011;59:797–814.PubMedCrossRefGoogle Scholar
  12. 12.
    Buckley JC, Wu AK, McAninch JW. Impact of urethral ultrasonography on decision-making in anterior urethroplasty. BJU Int. 2012;109:438–42.PubMedCrossRefGoogle Scholar
  13. 13.
    Barbagli G, De Stefani S, Sighinolfi MC, Annino F, Micali S, Bianchi G. Bulbar urethroplasty with dorsal onlay buccal mucosal graft and fibrin glue. Eur Urol. 2006;50:467–74.PubMedCrossRefGoogle Scholar
  14. 14.
    Guralnick ML, Webster GD. The augmented anastomotic urethroplasty: indications and outcome in 29 patients. J Urol. 2001;165:1496–501.PubMedCrossRefGoogle Scholar
  15. 15.
    El-Kassaby AW, El-Zayat TM, Azazy S, Osman T. One-stage repair of long bulbar urethral strictures using augmented Russell dorsal strip anastomosis: outcome of 234 cases. Eur Urol. 2008;53:420–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Barbagli G, Guazzoni G, Palminteri E, Lazzeri M. Anastomotic fibrous ring as cause of stricture recurrent after bulbar onlay graft urethroplasty. J Urol. 2006;176:614–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Elliot SP, Metro MJ, McAninch JW. Long-term follow-up of the ventrally placed buccal mucosa onlay graft in bulbar urethral reconstruction. J Urol. 2003;169(1754):2003.Google Scholar
  18. 18.
    Peterson AC, Delvecchio FC, Palminteri E, Lazzeri M, Guazzoni G, Barbagli G, Webster GD. Dorsal onlay urethroplasty using penile skin: a multi-institutional review of long term results. J Urol. 2003;169(S4):19, Abstract 72.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of UrologyMedical College of WisconsinMilwaukeeUSA

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