الفهرس 
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Abstract
(usually following traumatic catheterization or urethral instrumentation during TURP) and fall-astride perineal injuries (Sugimoto et al. 2005). The surgical treatment of bulbar urethral strictures, and indeed any urethral stricture, is determined by their aetiology, length, location and by previous surgical intervention (Mundy and Andrich. 2011).
Traditionally, short idiopathic bulbar strictures (typically 1–2 cm long) have been successfully managed by excision of the strictured urethral segment (the spongiofibrosis and the surrounding corpus spongiosum) and tension-free end-to-end anastomosis of the healthy spatulated edges (so called excision and primary anastomosis – EPA) (Morey et al. 2014, Mundy. 2005). The bulbar urethra is the commonest site for urethral strictures. Most cases are idiopathic, occurring most frequently at the junction of the proximal and middle thirds. Other common causes of bulbar urethral stricture are iatrogenic
The non-transecting technique for bulbar urethroplasty has been developed with the aim of achieving the same success as EPA without the morbidity associated with transection. Our experience with this technique include non-transecting excision of spongiofibrosis with preservation of well vascularised underlying spongiosum provides an excellent alternative to dividing the urethra during EPA (Mundy and Andrich. 2011).
Mean age of our study group was 35.47 years, with SD 13.1, and wide ranged from 18 to 56 years, etiology of bulbar urethral stricture was post inflammatory in 73.3% of our patients, and idiopathic post catheter in 26.7% of patients. Complain was difficulty in urination in 100% of our patients. Mean stricture length was 1.75 cm, with SD 0.25 cm and it ranged from 1.5 to 2 cm. Mean value of preoperative Q max was 7.37, with SD 1.9, and ranged from 5 to 10, mean value of The International Prostate symptom score (IPSS) was 13.7, with SD 3.2, and ranged from 9 to 19. Mean value of International Index of Erectile Function (IIEF) was 19.87, with SD 2.4, and ranged from 17 to 23. Mean of operative time in our study was 65.6 minutes, with SD 16.4, and it ranged from 40 to 90 minutes. Mean of blood loss was 78. 83 ml, SD 23.3, and ranged from 50 to 120 ml. Mean hospital stay was 4 days, with SD 1 day, and ranged from 3 to 6 days. Mean follow up of our patients was 5.6 months, SD 2 months, and ranged from 3 to 9 months. Intraoperative and postoperative complications in our study occurred in 4 patients only (13.3%).
The non-transecting approach to bulbar urethral strictures permits excision of the spongiofibrosis without compromising the integrity of spongiosal blood flow. When coupled with oral mucosal graft augmentation of the dorsal stricturotomy, this allows excision of the narrowest segment of a longer bulbar stricture, reconstituting the urethral plate to a wider calibre, avoiding an almost circumferential substitution in this area. This also permits the use of narrower and shorter oral grafts with reduced donor site morbidity (Bugeja et al. 2016).
Conclusion
Stricture aetiology is the main determinant of whether transection of the bulbar urethra is necessary or not. It is inevitable in trauma when the fibrosis must be completely excised and healthy urethral edges anastomosed to secure the most durable result. It is however certainly not necessary in short non-traumatic proximal bulbar strictures. A dorsal approach to these strictures coupled with a nontransecting technique prevents disruption of the integrity of ventral spongiosal blood flow and there are practical and theoretical reasons for doing so. Functional outcomes are equivalent to transection and end-to-end anastomosis with less surgical trauma. Minimising surgical trauma and preservation of blood supply are key principles for any surgical intervention, so The non-transecting anastomotic bulbar urethroplasty technique used appears to give results that are as good as those of traditional anastomotic urethroplsty.