Outcomes of single-stage buccal urethroplasty for glanular urethral strictures: the A. Goel technique compared with transurethral surgery

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Abstract
Introduction. Glanular urethral strictures pose a complex reconstructive challenge, as treatment must restore urethral patency while preserving penile anatomy and glanular aesthetics. Open buccal urethroplasty according to A. Goel demonstrates high efficacy but is associated with an invasive approach and a risk of local complications. Transurethral buccal urethroplasty combined with an ERAS protocol may reduce postoperative morbidity. Objective. To evaluate the efficacy and safety of transurethral buccal urethroplasty with an ERAS programme compared with open buccal urethroplasty according to A. Goel in patients with glanular urethral strictures. Materials & methods. A total of 118 patients with glanular urethral strictures were enrolled in a multicentre prospective comparative open-label parallel-group study. In group 1 (n = 56), open urethroplasty using a buccal graft according to A. Goel was performed under a standard perioperative protocol; in group 2 (n = 62), transurethral buccal urethroplasty was performed within an ERAS programme. The following outcomes were assessed: duration of catheterisation and hospital stay, pain severity, requirement for opioid analgesics, complications, recurrence rate, Qmax, IPSS, IIEF 5, quality of life, and treatment satisfaction. In addition, logistic regression analysis, neural network modelling, and recurrence free survival analysis were performed. Results. The groups were comparable in terms of age and stricture length. Recurrence free cure rates were 85.7% in the open urethroplasty group and 93.5% in the transurethral urethroplasty group, with a median follow up of 4.5 years (p > 0.05). The ERAS group exhibited shorter catheterisation (7 vs 14 days) and hospital stay (3 vs 10 days), lower rates of severe pain (3% vs 87%) and opioid requirement (3% vs 57%) (p < 0.001). Infectious complications were less frequent (10% vs 25%). Urethral fistulae and wound dehiscence occurred only after open surgery. Recurrence rates were 6.5% and 14.3%, respectively. Improvement in Qmax was +12.1 and +10.1 mL/s, and reduction in IPSS was -23.1 and -19.5, respectively (p > 0.05). Treatment satisfaction was higher in the ERAS group, at 89% vs 61% (p < 0.01). Conclusion. Transurethral buccal urethroplasty with an ERAS protocol is comparable to the open technique in terms of long term efficacy but provides a more favourable perioperative course, including reduced duration of catheterisation and hospitalisation, less pain, lower opioid requirement, and fewer local complications. This approach may be considered an effective and less traumatic treatment option for selected patients with glanular urethral strictures.

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