Table 2.
Comparative Summary of Surgical Reconstructive Techniques for VUAS Repair
| Procedure Type | Year | n | Stricture Length (cm) | Median FU Length (Months) | 1st Time Success* Rate | Major Complications (> Clavien Grade 3) | Continence (≤1 Pad Per day) | ||
|---|---|---|---|---|---|---|---|---|---|
| ABDOMINAL APPROACH | |||||||||
| Open | Retropubic end-to-end21 | 2011 | 20 | n/a | 63 | 60% | 0 | 64% | |
| Subtrigonal inlay patch with buccal mucosa graft60 | 2021 | 3 | n/a | 11 (5–14) |
100% | 0 | 100% | ||
| Robotic | Trans-peritoneal | End-to-end anastomosis23 | 2018 | 4** | n/a | 16.5 | 75% ** (2 of 4) | Osteitis pubis and pubo-vesical fistula (n=1) | 100% ** |
| YV plasty61 | 2017 | 2** | n/a | 4 and 50 | 100%** | 0 | 100%** | ||
| Anterior bladder flap62 | 2022 | 9 | n/a | 4.8 | 78% | Abdominal wall abscess (n=1) | 100% | ||
| Extra-peritoneal | End-to-end anastomosis63 | 2019 | 6 | n/a | 18.7 | 50% | 0 | 50% | |
| Inverted YV plasty64 | 2023 | 30 | n/a | 27 | 93.3% | GI haemorrhage (n=1) Urosepsis requiring ICU admission (n=1) |
n/a | ||
| PERINEAL APPROACH | |||||||||
| Open | Open end-to-end19 | 2017 | 23 | n/a | 45 | 87% | Intra-op rectal injury (n=1) Osteitis pubis (n=1) |
n/a (all incontinent pre-op) | |
| End-to-end anastomosis + subsequent AUS implantation65 | 2022 | 4** | 1.8 ** (1.5–2.3) | 61.5** (21–99) | 75%** | Erosion of AUS (n=2) | All incontinent before AUS | ||
| Urethroplasty with pull-through technique + subsequent AUS66 | 2012 | 11 | n/a | 65 | 91% | Erosion of AUS (n=1) | 81.8% | ||
| Anterior Sagittal Transrectal Approach (ASTRA)67 | 2023 | 1 | n/a | 5 | 100% | 0 | 0% | ||
| Dorsal Buccal Mucosal Graft Urethroplasty68 | 2019 | 4 | 2.5 | 3 | 100% | 0 | n/a (all incontinent pre-op) | ||
| Robotic | Perineoscopic bladder neck reconstruction69 | 2021 | 16 | n/a | 13.2 ± 7 | 81.25% | Pubo-vesical fistula (n=1) | 0% | |
| ABDOMINO-PERINEAL (AP) APPROACH | |||||||||
| Open | AP dissection, partial pubectomy, omental wrapping, repeat anastomosis70 | 1995 | 2 | >1.5 | 7–18 | 100% | 0 | 100% | |
| AP excision and end-to-end anastomosis + AUS ± clam ileo-cystoplasty20 | 2000 | 6 | 2.5–3.5 | 8–56 | 83% | Anastomotic leak and AUS erosion (n=1) | 83.3% (all incontinent pre-op) | ||
| Robotic | Robotic AP approach (with separation of corpora cavernosa)71 | 2017 | 1 | 4.5 | 12 | 100% | 0 | 1pad/day | |
| Single-port AP, urethroplasty with buccal mucosa graft with rectus abdominis, omental or gracilis flaps as needed72 | 2021 | 7** | 3.9 (2.5–6.5) | 11.7 | 57.14%** (4 of 7) | Hernia with bowel obstruction needing laparotomy (n=1) | 100%** | ||
| MIXED REPORTS INCLUDING ALL APPROACHES | |||||||||
| Open | Nikolavsky et al73 | 2014 | 12 | 2.5 (1–5) |
75.5 | 66.7% | Persistent urinary extravasation after abdominal approach (n=1) | 33.3% | |
| Wessels et al74 | 1998 | 4 | n/a | 33.8 | 75% | 0 | 0% | ||
Notes: Definition of success – no evidence of re-stricture requiring further treatment. ** - actual reported sample size of patient who had BNC after prostatectomy, outcomes adjusted accordingly.
Abbreviations: GI, Gastrointestinal; ICU, Intensive care unit; AUS, Artificial urinary sphincter.