Upper transverse scrotal approach for muscle- and nerve-sparing urethral stricture repair

Open surgery on bulbar urethral strictures has become a widespread procedure. While there is inconsistency which procedure to perform at the bulbar region, there is consistency of the used incisional approach despite of several potential disadvantages. Therefore, to bypass disadvantages, we performed an upper transverse scrotal approach for stricture repair in the pendulous urethra and the distal bulbar urethra as previously reported for the placement of an artificial urinary sphincter. Thirteen patients (n = 13) with bulbar urethral stricture were operated by upper transverse scrotal incision approach. On five patients a free foreskin graft in dorsal onlay technique was performed. Eight patients obtained an end-to-end-anastomosis procedure. Pre- and postoperative uroflowmetry as well as retrograde urethrocystography were done. Pre- and postoperative residual postvoid urine were estimated by transabdominal ultrasound. The patients were followed-up for up to 12 months. After stricture repair, Qmax improved from mean 9.0 mL/s (SD +/- A 3.2) preoperatively to mean 20.3 mL/s (SD +/- A 3.1), postoperatively. Postvoid residual urine decreased from mean 90.0 mL (SD +/- A 68.7) to mean 41.5 mL (SD +/- A 16.1). All retrograde urethrocystographies showed regular reconstructed urethral conditions. The upper transverse scrotal incision may combine the advantages of a less traumatical approach with the excellent results of perineal approach.