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V058: Double-face augmentation urethroplasty for bulbar urethral strictures-dorsal versus ventral approach: Technical implications and short-term outcomes

Dr. B. (Bhavatej) Enganti
Enganti B., Chiruvella M., Bendigeri M.T., Ghouse S.M., Ragoori D., Reddy P.C., Pandya S.
Asian Institute of Nephrology & Urology, Dept. of Urology, Hyderabad, India
35th Annual EAU Congress - Virtual (EAU20V)
17 July 2020
Uro-genital Reconstruction, Urethral Strictures - Treatment, Surgical Open

Introduction & Objectives

Double-face augmentation urethroplasty (DFAU) is a technique indicated in near obliterative bulbar urethral strictures. It can be performed by either dorsal (DoVi) or ventral (VoDi) approach. To present the technical implications and compare the short-term outcomes of dorsal versus ventral approach DFAU in near obliterative bulbar urethral strictures.

Materials & Methods

This was a retrospective evaluation of a prospectively maintained database of patients with bulbar urethral strictures (>2cm) who underwent DFAU from January 2016 to May 2019. The decision to consider dorsal or ventral approach is 1) to identify the landmark- bulbospongiosus muscle (distal extent) at the level of bulbar urethra in relation to the distal extent of the urethral stricture, and 2) Corpus spongiosum width. In DFAU, the inlay augmentation was done at the level of narrow urethral plate (< 6 Fr) with focal dense spongiofibrosis and overlapping of the distal and proximal edges of the grafts was avoided. DoVi was considered in all circumstances especially when the extent of the bulbar urethral stricture was distal to the bulbospongiosus muscle and in strictures with corpus spongiosum width <15 mm. VoDi was considered when the distal extent of bulbar urethral stricture was proximal to the distal extent bulbospongiosus muscle, corpus spongiosum width >15mm and proximal bulbar urethral strictures. Patients with minimum follow-up of 6 months were included in the study. Patients follow-up data of AUA symptom score and uroflometry was assessed at 3rd monthly for the 1st year and at 6 months thereafter. A successful outcome was defined as normal urinary flow rate without any obstructive voiding symptoms.


Total 52 patients with the mean age of 48 years underwent DFAU for bulbar urethral strictures. 30 patients underwent DFAU (DoVi) and 22 patients underwent DFAU (VoDi). Mean stricture length (5.8 cm (DoVi); 5.1 cm (VoDi) was comparable between the groups. There was significant improvement in peak flow rates at 6 months (DoVi: 25 ± 4 ml/sec; VoDi: 29 ± 5 ml/sec]) when compared to preoperative parameters (DoVi: 6 ± 2 ml/sec; VoDi: 5 ± 2ml/sec]) in both groups. Mean follow-up was 22 months (IQR:6-40). Failures were noted in 7 patients: DoVi (4 patients) and VoDi (3 patients).


Dorsal approach or ventral approach DFAU should be decided intra-operatively based on the extent of the stricture in relation to the bulbospongiosus muscle and the degree of spongiofibrosis. Dorsal approach (DoVi) is versatile and can be considered in all circumstances. Ventral approach (ViDo) though technically easy, should be performed selectively in patients with proximal bulbar urethral strictures, prior failed urethroplasty and morbid obesity. The short-term outcomes were comparable in both dorsal and ventral approach of DFAU.

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