Preliminary Application of a Novel Anatomic Urethroplasty Technique Using Everted Saphenous Vein Graft for Long Penile Urethral Strictures

Background: This paper reports two cases of anatomic urethroplasty (AU) using everted saphenous vein graft (eSVG) with long penile urethral strictures. The preliminary feasibility and safety of the operation are also analyzed. Methods: Two men with penile urethral strictures (5.5 cm and 5.0 cm) were treated with AU using eSVG. The highlight of this novel surgical technique was the anatomical repair of the layer of the narrowed urethral wall without affecting the continuity of the layer of corpus spongiosum. Moreover, the pre- and postoperative Urodynamics and Night Penis Tumescence and Rigidity test results were compared. Results: Complications, such as hematoma, urinary fistula, or urethral strictures, were not observed at 2 weeks postoperatively. At 6 months postoperatively, the urination status and urodynamic indexes of the patients had significantly improved compared with that preoperatively. There was no significant change in erection function before and after the operation. Conclusions: Repairing long penile urethral strictures with AU using eSVG is safe and feasible and can be used as an alternative treatment method.

urethral stricture; everted saphenous vein graft; urethroplasty

[1] Alwaal A, Blaschko SD, McAninch JW, Breyer BN. Epidemiol-ogy of urethral strictures. Translational Andrology and Urology. 2014; 3: 209–213.

[2] Lazzeri M, Sansalone S, Guazzoni G, Barbagli G. Incidence, Causes, and Complications of Urethral Stricture Disease. Euro-pean Urology Supplements. 2016; 15: 2–6.

[3] Barbagli G, Pellegrini G, Corradini F, Montorsi F, Sansalone S, Butnaru D, et al. One-stage Penile Urethroplasty Using Oral Mu-cosal Graft and Glue. European Urology. 2016; 70: 1069–1075.

[4] el-Morsi AR. Venous patch urethroplasty. The Journal of the Egyptian Medical Association. 1974; 57: 198–201.

[5] Mangera A, Patterson JM, Chapple CR. A Systematic Review of Graft Augmentation Urethroplasty Techniques for the Treat-ment of Anterior Urethral Strictures. European Urology. 2011; 59: 797–814.

[6] Akhtar A, Khattar N, Goel H, Rao S, Tanwar R, Sood R. Looking beyond oral mucosa: Initial results of everted saphenous vein graft urethroplasty (eSVGU) in long anterior urethral strictures. Arab Journal of Urology. 2017; 15: 228–235.

[7] Stein DM, Thum DJ, Barbagli G, Kulkarni S, Sansalone S, Pardeshi A, et al. A geographic analysis of male urethral stricture aetiology and location. BJU International. 2013; 112: 830–834.

[8] Hampson LA, McAninch JW, Breyer BN. Male urethral stric-tures and their management. Nature Reviews Urology. 2014; 11: 43–50.

[9] Yalcinkaya F, Zengin K, Sertcelik N, Yigitbasi O, Bozkurt H, Sarikaya T, et al. Dorsal onlay buccal mucosal graft urethro-plasty in the treatment of urethral strictures-does the stricture length affect success? Advances in Clinical and Experimental Medicine. 2015; 24: 297–300.

[10] Smith TG. Current management of urethral stricture disease. In-dian Journal of Urology. 2016; 32: 27–33.

[11] Levy AC, Vanni AJ. Refractory Urethral Stricture Management: Indications for Alternative Grafts and Flaps. Current Urology Reports. 2018; 19: 20.

[12] Osman NI, Hillary C, Bullock AJ, MacNeil S, Chapple CR. Tis-sue engineered buccal mucosa for urethroplasty: Progress and future directions. Advanced Drug Delivery Reviews. 2015; 82–83: 69–76.

[13] Castiglione F, Dewulf K, Hakim L, Weyne E, Montorsi F, Russo A, et al. Adipose-derived Stem Cells Counteract Urethral Stric-ture Formation in Rats. European Urology. 2016; 70: 1032–1041.

[14] Kim BS, Kim HT, Kwon SY, Chun SY, Choi KH, Park M, et al. Nontransected ventral onlay-augmented urethroplasty using autologous saphenous vein graft in a rabbit model of urethral stricture. Urology. 2014; 83: 225–231.

[15] Li D, Shen Z, Xu Y. Tubularized urethral reconstruction using everted saphenous vein graft in a beagle model. BMC Urology. 2021; 21: 63.