Extended Primary Anastomosis with Penile Plication (EPAPP): A Promising New Alternative to Perineal Urethrostomy for Reconstruction of Long Urethral Strictures.

ABSTRACT Objectives To present excision and primary anastomosis (EPA) urethroplasty as a highly reliable method of reconstruction for short bulbar urethral strictures. Longer strictures are often managed with grafting techniques to ensure a tension free repair. Here we report our initial experience with a new, extended anastomotic technique for long bulbar strictures that incorporates plication of the ventral corporal bodies to reduce the distance between the urethral ends and obviates the need for grafting. Methods We reviewed records for all urethroplasties performed by a single surgeon at our institution between January 2018 and February 2020. We identified a cohort of older patients with complex strictures who underwent Extended Primary Anastomosis with Penile Plication (EPAPP). Patient demographics, stricture characteristics, perioperative parameters, and post-operative outcomes were evaluated. Results Of 346 urethroplasty records reviewed, ten patients (2.9%) underwent EPAPP. Mean stricture length was 3.75 ± 1.4 cm. EPAPP patients were older than those repaired by other techniques (mean age 66.6 vs. 55.6, p = 0.024), and most were not sexually active pre-operatively. Postoperative voiding cystourethrogram confirmed urethral patency without extravasation in all patients. At a median follow up of 9.7 months (IQR 8.5-11.5) eight patients remained asymptomatic after EPAPP alone and two patients required a single balloon dilation for stricture recurrence. Conclusions EPAPP is a promising alternative option for the management of long bulbar strictures among appropriately selected patients.