Clinical observation of male bulbar urethral strictures resulting from straddle injuries associated with falling from heights and riding activities.

OBJECTIVES: To retrospectively investigate and analyze the characteristics of male bulbar urethral strictures or occlusions resulting from straddle injuries caused by falling from heights and riding activities. METHODS: The study included 56 patients with a history of straddle injury, who were divided into two groups: the falling group (n = 29) and the riding group (n = 27). All patients underwent urethroscopy and X-ray urethrography, followed by urethrotomy and anastomotic procedure. Both urethral and suprapubic catheters were retained for one month postoperatively. Subsequent follow-up assessments were conducted within one month to one year after surgery. RESULTS: The clinical data of two groups were analyzed. The average ages were 40.1 ± 11.2 (falling group, aged 18-59) and 26.8 ± 4.4 (riding group, aged 19-35), P < 0.05. In the falling group, 21 cases (72.4%) had offspring, while in the riding group, only 3 cases (11.1%) had offspring, P < 0.05. The stricture segments in the falling group were predominantly located in the proximal part of the bulbar region (89.7%), whereas in the riding group they mainly found in the distal part (96.3%), P < 0.05. In terms of urethrography results, the average lengths of stricture segments were measured as 17.6 ± 2.8 mm and 15.5 ± 4.6 mm respectively, P < 0.05. During surgery, the average lengths of stricture segments were recorded as 19.0 ± 2.5 mm and 17.4 ± 6.1 mm, P > 0.05. In the falling group, 20 cases (69.0%) involved bulbocavernosus muscle injury, P < 0.05. In the riding group, 5 cases (18.5%) involved corpus cavernosum injury, P < 0.05. After one month of the operation, all cases were able to pass through the 16Fr urethroscope without any apparent urethral strictures or complications observed in urethrography results. The maximum urinary flow rate for all cases exceeded 15 ml/s. Two months and one year after the operation, all cases experienced smooth urinary flow and ejaculation without any disorders reported. 3 cases (10.3%) in the falling group and 7 cases (25.9%) in the riding group complained of urethral stretching pain during erection, P > 0.05. CONCLUSIONS: Male bulbar urethral strictures or occlusions resulting from straddle injuries associated with falling from heights and riding activities exhibit distinct characteristics, necessitating the development of a comprehensive surgical plan tailored to the specific features of each condition and the diverse age groups affected.

Buccal mucosa graft urethroplasty for bulbar urethral stricture: Outcomes andpredictive factors affecting success.

INTRODUCTION AND OBJECTIVE: The bulbar urethra is the location where urethral stricture is most commonly observed. The most successful method for long and recurrent urethral stenosis is graft urethroplasty. The most successful graft source is buccal mucosa, with advantages like easy adaptation to the corporeal bed, thick epithelium, thin lamina propria with rich vascular structure and easy ability to obtain the graft. In this study we aimed to retrospectively assess the outcomes and predictive factors affecting surgical success of our buccal mucosal graft urethroplasty surgery performed for bulbar urethra stenosis with moderate length. MATERIAL AND METHOD: In this study, we monitored 51 patients with mean 4.4 cm bulbar urethral stricture length for mean 17 months follow-up. From operative and postoperative data, stenosis length, operation duration, Qmax, International Prostate Symptom Score, International Index of Erectile Function-Erectile Function and OF, success rates in total and in subgroups (age, according to DVIU, etiology, BMI and DM), follow-up duration, complications, re-stricture time and number were assessed. RESULTS: The total success of the operations was 86.3%. In 17 months, the re-stricture rate was 13.7%. Oral and urethral complications were all minor. The complications with longest duration (6 months) were ejaculation, erection problems and urethral fistula. Mean time to re-stricture was 11 months. All re-stricture patients were relieved by one DVIU session each. CONCLUSION: For bulbar urethral stricture longer than 2 cm and with recurrence, the dorsal buccal mucosa graft replacement is a very successful method with low complication rates.

Uretroplastia con injerto de mucosa oral para la estenosis de uretra bulbar: resultados y factores predictivos asociados al éxito / Buccal mucosa graft urethroplasty for bulbar urethral stricture: Outcomes and predictive factors affecting success

Introducción y objetivo La uretra bulbar es la localización en la que se observa con más frecuencia la estenosis uretral. La técnica con mayores tasas de éxito para el tratamiento de estenosis largas y recurrentes que facetan la uretra es la uretroplastia con injerto. La procedencia del injerto que ha mostrado resultados más satisfactorios es la mucosa oral, por sus beneficios como la fácil adaptación al lecho de cuerpos cavernosos, un epitelio grueso, una lámina propia fina con una estructura vascular rica, además de ser fácil de obtener. En este estudio nos propusimos evaluar retrospectivamente los resultados de nuestra cirugía de uretroplastia con injerto de mucosa oral realizada para la estenosis de uretra bulbar con longitud moderada y los factores predictivos asociados al éxito quirúrgico. Material y métodos En este estudio se evaluó a 51 pacientes con una longitud media de 4,4cm de estenosis de uretra bulbar durante una media de 17 meses de seguimiento. A partir de los datos operatorios y postoperatorios, se evaluó la longitud de la estenosis, el tiempo quirúrgico, el Qmáx, el International Prostate Symptom Score, el International Index of Erectile Function-Erectile Function y la OF, las tasas de éxito globales y por subgrupos (edad, según sesiones de UIVD, etiología, índice de masa corporal y diabetes mellitus [DM]), la duración del seguimiento, las complicaciones, el tiempo y el número de reestenosis. Resultados El éxito global de las intervenciones fue del 86,3%. En 17 meses, la tasa de reestenosis fue del 13,7%. Las complicaciones orales y uretrales fueron todas menores. Las complicaciones de mayor duración (6 meses) fueron los trastornos de eyaculación y erección y la fístula uretral. El tiempo medio de reestenosis fue de 11 meses. Todos los pacientes con reestenosis se resolvieron con una sesión de UIVD cada uno (AU)

Introduction and objective The bulbar urethra is the location where urethral stricture is most commonly observed. The most successful method for long and recurrent urethral stenosis is graft urethroplasty. The most successful graft source is buccal mucosa, with advantages like easy adaptation to the corporeal bed, thick epithelium, thin lamina propria with rich vascular structure and easy ability to obtain the graft. In this study we aimed to retrospectively assess the outcomes and predictive factors affecting surgical success of our buccal mucosal graft urethroplasty surgery performed for bulbar urethra stenosis with moderate length. Material and method In this study, we monitored 51 patients with mean 4.4cm bulbar urethral stricture length for mean 17 months follow-up. From operative and postoperative data, stenosis length, operation duration, Qmax, International Prostate Symptom Score, International Index of Erectile Function-Erectile Function and OF, success rates in total and in subgroups (age, according to DVIU, etiology, BMI and DM), follow-up duration, complications, re-stricture time and number were assessed. Results The total success of the operations was 86.3%. In 17 months, the re-stricture rate was 13.7%. Oral and urethral complications were all minor. The complications with longest duration (6 months) were ejaculation, erection problems and urethral fístula. Mean time to re-stricture was 11 months. All re-stricture patients were relieved by one DVIU session each. Conclusion For bulbar urethral stricture longer than 2cm and with recurrence, the dorsal buccal mucosa graft replacement is a very successful method with low complication rates (AU)

[Urethroplasties for male urethral strictures: Success rates and predictive factors]. / Urétroplasties pour sténoses de l'urètre masculin : taux de succès et facteurs prédictifs.

INTRODUCTION: Urethroplasty has reported success rates ranging from 60 to 98%. Predictive factors for recurrence are rarely studied, postoperative urinary drainage modalities are not investigated. The primary objective was to evaluate the success rate of urethroplasty in our center. Secondary objectives were to identify recurrence predictive factors. METHODS: A single-center retrospective cohort including men treated with urethroplasty for stricture between 2007-2017, followed up for a minimum of 12 months. Recurrence was defined as the necessity of a new procedure (endo-urethral or surgical). Data from penile urethra (SUP) and bulbo-membranous urethra (SUBM) stenosis were analyzed separately. Recurrence-free survival (success) was analyzed according to the Kaplan-Meier model. The characteristics of the patients, the stenosis, the surgical technique, the modalities of postoperative urinary drainage were analyzed in subgroups for the bulbo-membranous urethra looking for a correlation with recurrence. RESULTS: A total of 103 patients included: 25 with SUP, 78 with SUBM. The overall success rate was 69%, CI95% [60-79] with a mean follow-up of 62.85 months. The success was 68%, CI95%[46-82] for SUP, 69.23%, CI95% [58-78] for SUBM. Recurrences occurred during the first 12 months. Only postoperative suprapubic urinary drainage was a predictive factor (HR=0.947, CI95% [0.905-0.992]). A period longer than 14 days reduced recurrence by 37%. CONCLUSION: Urethroplasty had a success rate of 69%, comparable to published series. Suprapubic urinary drainage improved the surgery outcomes. LEVEL OF PROOF: 2, Grade B.

A novel stricture prevention technique in blunt urethral injury: A multi-center retrospective observational study.

PURPOSE: Bulbar injury is the most common type of urethral injury. This study investigated the efficacy and safety of a novel technique, local urethral flushing, in preventing stricture formation after blunt bulbar urethra injuries. MATERIALS AND METHODS: This retrospective study included 205 males diagnosed with straddle injury-induced bulbar urethra injury at the Shanxi Bethune Hospital and First Hospital of Shanxi Medical University between January 2015 and January 2019. Patients were diagnosed by retrograde urethrography and classified as partial or complete urethral rupture according to the urethral integrity after injury. Complete urethral rupture patients received suprapubic cystostomy and received urethroplasty 3 months later. Patients with partial urethral rupture underwent endoscopic urethral realignment by cystoscopic guide-wire guided catheterization. Patients with both injury types were divided into 3 groups. The treatment groups received urethral flushing with 0.05% dexamethasone through a secondary ureteral catheter that locked at the urethral lesion. The blank control groups received normal saline. The negative control groups had only a single ureteral catheter placed. Patients were assessed for pain during catheterization, infection, and stenosis, and followed for at least 2 years. RESULTS: Stenosis rates and length were significantly reduced in the normal saline groups, and even further reduced in the dexamethasone groups. The negative control groups had significantly higher infection rates than patients in the dexamethasone or saline groups. CONCLUSIONS: Local urethral flushing with dexamethasone could significantly decrease urethral stenosis rates and severity without increasing patients' discomfort or infection risk.

Long-term outcome of Non-Transecting Anastomotic Bulbar Urethroplasty for Urethral Strictures: An 8-year experience from Liaquat National Hospital Karachi.

OBJECTIVES: To determine the long-term outcome and complications of non-transecting anastomotic bulbar urethroplasty for the treatment of small bulbar urethral strictures presenting at Liaquat National Hospital, Karachi. METHODS: This interventional study was conducted from January 2012 to December 2019 with the study duration of eight year at Liaquat National Hospital, Karachi. All patients presenting in the outpatient department with urethral strictures were included in the study. Patients were evaluated postoperatively for complications and outcomes were determined. The data was analyzed using SPSS v.25. RESULTS: A total of 358 patients were treated with non-transecting anastomotic bulbar urethroplasty during this 8-years period. The most common site of stricture formation was bulbar urethra 186 (50%), followed by bulbo-membranous urethra; 103 (31%), and bulbo-penile urethra; 69 (19%). The mean stricture was 1.2 cm (0.5-2.5 cm) in length. The main postoperative complications were scrotal swelling in 7 (1.9%), wound infection in 6 (1.6%), wound dehiscence in 3 (0.8%), and transient sexual dysfunction in 31 (8.6%) patients with an overall initial success rate of 97.8%. No permanent deficit in sexual function was reported. CONCLUSIONS: Non-transecting anastomotic bulbar urethroplasty has a good outcome with insignificant postoperative complications in patients with small bulbar urethral stricture disease.

The efficacy of non-transecting uerthroplasty in the management of bulbar urethral stricture / 中华泌尿外科杂志

Objective:To compare efficacy and erectile function outcome of Non-transecting Urethroplasty (NTU)with excision and primary anastomotic urethroplasty(EPA) in the management of bulbar urethral stricture.Method:A retrospective analysis of the case data of 73 patients with bulbar urethral stricture admitted to Shanghai Sixth People's Hospital from January 2016 to December 2019. The patients are 18 to 60 years old, because of the stenosis of the bulbous urethra, the length of the stenosis is less than 2 cm, and there is no history of urethral surgery, no multiple urethral stricture, and no obvious ED before surgery. According to the operation method, the patients were divided into 25 cases in NTU group and 48 cases in EPA group. The ages of the NTU group and the EPA group were (39.2±9.4) years and (42.1±9.3) years, respectively. The course of the disease was 6.0(3.0-14.0) months and 6.5(3.0-11.0) months, respectively, and the body mass index was (23.7±3.2) kg/m 2 and (24.5±2.7) kg/m 2, the preoperative maximum urine flow rate (Q max) was (8.7±4.3) ml/s and (7.9±4.6) ml/s, respectively, and the length of the stenosis was respectively (1.7±0.4) cm and (1.8±0.2) cm, the preoperative International Erectile Function Questionnaire (IIEF-5) was (20.9±1.9) points and (21.3±2.1) points, respectively, the difference was not statistically significant ( P>0.05). The etiology of NTU group and EPA group were 8 cases (32.0%) and 31 cases (64.6%) of trauma, 11 cases (44.0%) and 9 cases (18.8%) of iatrogenic injury, and 6 cases (24.0%) and 8 cases (16.7%), the difference was statistically significant ( P=0.023). All operations were performed by the same team of doctors. The urethral scar was assessed during the operation. If the scar tissue can be completely removed without breaking the urethra, NTU is performed. The distal end of the urethra is cut at the dorsal side of the narrow segment of the urethra, and the urethral scar is removed in a transverse wedge shape. The urethra is sutured; otherwise, EPA is performed, the urethra is completely cut off, the stricture of the urethra and surrounding scar tissue is completely removed, and the urethra end-to-end anastomosis is performed. Record the operation time and intraoperative bleeding. Difficulty urinating after surgery, urethral microscopy and urethral angiography showed that the urethral stricture at the surgical site was defined as a failure of the operation. The urinary catheter was removed 3 weeks after surgery, urine flow rate was measured at 3 weeks, 6 months, and 12 months after surgery, erectile function was evaluated 12 months after surgery, and urethral angiography was performed 1 to 2 years after surgery. Result:All 73 operations in this study were successfully completed. The operation time of NTU group and EPA group were (67.6±11.3) min and (62.7±10.1) min, respectively, and the difference was not statistically significant ( P=0.063); intraoperative blood loss was (71.6±16.2) ml and (86.0±20.8) ml, the difference was statistically significant ( P=0.004). The postoperative median follow-up time was 18.0 months (13-38 months). The surgical success rates of the NTU group and EPA group were 92.0%(23/25) and 93.8%(45/48), respectively. The Q max of the NTU group and the EPA group were (26.7±3.6) ml/s and (28.1±8.7) ml/s, (25.2±3.5) ml/s and (26.7±8.1) ml/s, (25.0±4.3) ml/s and (26.2±7.2) ml/s; the IIEF-5 scores were (21.8±1.6) and (20.6±2.9) points respectively at 12 months after operation, the difference was both No statistical significance ( P>0.05). There was a statistically significant difference in IIEF-5 between NTU group and preoperative ( P=0.023). Conclusion:NTU can achieve the same outcomes as EPA in the management of bulbar urethral stricture. More importantly, the continuance of bulbar urethra is attained and avoiding rupture of bulbar cavernous artery, so as to protect the blood supply of penile and erectile function. NTU is a minimally invasive, feasible surgical method, which is advised for the patients with shorter stricture segment and fewer fibrosis.

Initial experience with Allium™ stent in the management of bulbar urethral stricture.

We herein present our initial experience of a short series with the Allium™ Bulbar Urethral Stent (BUS) in the management of bulbar urethral disease. This Allium™ stent is a self-expandable metal stent which is intended for temporary placement. Our series is a retrospective analysis of 15 BUS placements in 13 patients conducted during 2014 to 2016. BUS was placed successfully after visual internal urethrotomy (VIU) in all patients. Stent insertion was successful in 8 patients (62%) with a mean follow up of 7.2 months (range, 2-12 months). Two of the failed patients stents were reinserted had repeat stenting with a successful outcome. The result of this short series suggests that BUS may have a limited role in the management of bulbar urethral stricture disease.

A new technique for immediate endoscopic realignment of post-traumatic bulbar urethral rupture.

OBJECTIVES: Urethral injury with partial or complete disruption of urethral integrity can lead to voiding problems and serious infections. We report a new management technique involving immediate endoscopic realignment with drainage via peel-away sheath for post-traumatic bulbar urethral rupture. METHODS: Thirteen patients presenting with post-traumatic bulbar urethral rupture between July 2010 and May 2013 were treated. An 18F peel-away sheath was inserted into the anterior urethra, then a ureteroscope or nephroscope was inserted into the peel-away sheath with continuous normal saline infusion and drainage through the cavity between ureteroscope and sheath to maintain operative field clarity. A guide wire was negotiated across the disruption to the bladder and an 18F Foley catheter inserted for 2-4 weeks. Rupture severity was evaluated by urethroscopy during operation. Two patients had partial urethral rupture and 11 complete rupture. Before Foley catheter removal, pericatheter urethrography was performed to determine if urinary extravasation had occurred. Urethroscopy was performed after catheter removal. Follow-up uroflowmetry was conducted monthly for 1 year. RESULTS: This technique was successful in all patients and none experienced urinary extravasation or required open surgery. Mean operation time was 4.9±1.6 min (3-8 min) and the mean Foley catheter indwelling time was 25.8±5.3 days. During follow-up (18.4±5.4 months, 12-26 months), 6 patients developed urethral strictures (8.7±10.5 weeks, 1-28 weeks post-treatment). Strictures were managed by internal urethrotomy (1 patient) or urethral sound dilation (5) without open urethroplasty. CONCLUSIONS: Immediate endoscopic realignment with drainage via peel-away sheath is a fast, effective, and safe technique for bulbar urethral rupture.

Treatment for long bulbar urethral strictures with membranous involvement using urethroplasty with oral mucosa graft.

INTRODUCTION: Urethroplasty with oral mucosa grafting is the most popular technique for treating nontraumatic bulbar urethral strictures; however, cases involving the membranous portion are usually treated using progressive perineal anastomotic urethroplasty. We assessed the feasibility of performing dorsal (or ventral) graft urethroplasty on bulbar urethral strictures with mainly membranous involvement using a modified Barbagli technique. MATERIAL AND METHODS: This was a prospective study of 14 patients with bulbomembranous urethral strictures who underwent dilation urethroplasty with oral mucosa graft between 2005 and 2013, performed using a modified technique Barbagli, with proximal anchoring of the graft and securing of the graft to the tunica cavernosa in 12 cases (85.7%) and ventrally in 2 (14.3%). The minimum follow-up time was 1 year. We evaluated the subjective (patient satisfaction) and objective (maximum flow [Qmax] and postvoid residual volume [PVRV], preoperative and postoperative) results and complications. Failure was defined as the need for any postoperative instrumentation. RESULTS: A total of 14 patients (median age, 64+13 years) underwent surgery. The main antecedent of note was transurethral resection of the prostate in 9 cases (64.3%). The median length of the stenosis was 45+26.5mm. Prior to surgery, 50% of the patients had been subjected to dilatations and 4% to endoscopic urethrotomy. The mean surgical time and hospital stay were was 177+76min and 1.5+1 day, respectively. The preoperative Qmax and PVRV values were 4.5+4.45mL/sec and 212.5+130 cc, respectively. The postoperative values were 15.15+7.2mL/sec and 6+21.5cc, respectively (P<.01 for both comparisons). Surgery was successful in 13 cases (92.9%). None of the patients had major complications. There were minor complications in 1 (7.1%) patient, but reintervention was no required. CONCLUSION: The repair of long bulbar urethral strictures with membranous involvement using urethroplasty with free oral mucosa grafts represents a viable alternative for patients with nontraumatic etiology and little fibrosis. The dilation of the urethral lumen achieves good results with minimum failure rates and little probability of complications. For many of these patients, the length of the stricture is too long to perform the tension-free anastomosis technique.

Cobb's collar occurring in two brothers in a family: A rare entity revisited.

Most urethral strictures arise from iatrogenic, traumatic, or inflammatory causes. We report the familial occurrence of a congenital bulbar urethral stricture in two brothers. Retrograde and voiding cystourethrography was performed. A Cobb's collar was diagnosed after radiological and endoscopic evaluation in both cases and was successfully managed with urethroplasty. Cobb's collar is a rarely recognized cause of a membranous stricture of bulbar urethra that can lead to several urinary problems. In cases of adolescent and young adults presenting with symptoms of progressive urinary obstruction and enuresis with or without urinary tract infection, Cobb's collar can be seen as a minor constriction in the bulbar urethra, but is not frequently symptomatic, and the familial occurrence of such a stricture is even rarer.

The Efficacy of Bulbar Urethral Mobilization for Anastomotic Anterior Urethroplasty in a Case With Recurrent Anterior Urethral Stricture.

A 2-month-old boy was diagnosed with febrile urinary tract infection. Voiding cystourethrography showed bulbar and anterior urethral strictures, and endoscopic internal urethrotomy was performed. He developed febrile urinary tract infection again and revealed the recurrence of the anterior urethral stricture. Consequently, endoscopic internal urethrotomy was performed 4 times. Because the anterior urethral stricture had not improved, he was referred to us. Anterior urethroplasty was performed when he was 5 years. After excision of the scarred portions of the urethra, the defect of the urethra was 20 mm. Transperineal bulbar urethral mobilization was performed, and a single-stage end-to-end anterior urethroplasty without tension could be performed simultaneously.

Ventral oral mucosal onlay graft urethroplasty in nontraumatic bulbar urethral strictures: surgical technique and multivariable analysis of results in 214 patients.

BACKGROUND: The ventral oral mucosal onlay graft is suggested in proximal bulbar strictures where the thick spongiosum provides excellent support to the graft. Some technical steps used in this technique are currently under debate in the literature. OBJECTIVE: To describe the surgical steps of this urethroplasty and investigate predictive factors of success using a multivariable logistic regression analysis. DESIGN, SETTING, AND PARTICIPANTS: This is a descriptive observational retrospective study of 214 patients who underwent urethroplasty for bulbar urethral strictures between May 1999 and November 2010 in a single high-volume center. Study inclusion criteria were patients presenting nontraumatic bulbar urethral strictures ranging from 1.3 cm to 6.8 cm in length. Exclusion criteria were traumatic strictures, panurethral strictures, lichen sclerosus, and failed hypospadias repair. SURGICAL PROCEDURE: The oral graft was placed on the ventral bulbar urethral surface and pushed as proximally as possible using dedicated instruments and surgical techniques. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome measure was the objective result, defined as the absence of stricture recurrence at follow-up. The objective outcome was considered a failure when any postoperative instrumentation was needed. Multivariable logistic regression analysis was developed. All tests were two sided with a significance level set at 0.05. RESULTS AND LIMITATIONS: Median follow-up was 54 mo. Of the 214 patients, 183 (85.5%) were successful and 31 (14.5%) were failures. The preoperative maximum flow rate (Qmax) was a significant predictor of surgical outcome (odds ratio: 1.352; p = 0.001). Age, length, and type of stenosis, and previous treatment were not significant predictors of surgical outcome (all p > 0.05). The limitation of our survey is the absence of a subjective evaluation or the use of specific tools, such as a questionnaire. CONCLUSIONS: Ventral oral graft urethroplasty represents a valid option in nontraumatic bulbar strictures. Preoperative Qmax may be predictive of urethroplasty failure.

Unusual urethral metastasis from colon carcinoma presenting with difficult urination and hematuria.

Urethral metastases originating from the colon are extremely rare. We report a case of a 67-year-old man who presented with difficult urination and hematuria. Diagnostic cystoscopy showed an abnormal, exophytic lesion in his proximal penile urethra a bulbar urethra. His pathology was diagnosed as adenocarcinoma consistent with colon metastasis.

Reconstruction of Obliterated Vesicourethral Junction: Use of the Bulbar Urethra as a Continent Valve.

Reconstruction of the obliterated vesicourethral junction is both complex and difficult. Here, we report an innovative method using a mobilized bulbar urethra as a continent valve. Three patients with major problems at the vesicourethral junction underwent continent valve reconstruction. In cases 1 and 2, in which there were problems at the anastomosing site after radical prostatectomy, the bladder wall was closed, wedge resection of the midline pubic bone was performed, and a fully mobilized bulbar urethra was implanted submucosally into the anterior bladder wall. In case 2, augmentation cystoplasty using an ileal segment was required due to the small capacity of the bladder. In case 3, in which there was posterior urethra disruption associated with pelvic fracture, the bulbar urethra was implanted into the bladder wall in the same manner as in cases 1 and 2 without pubectomy. The postoperative follow-up periods were 48, 36, and 12 months, respectively. In all patients, urinary management was achieved by self-catheterization postoperatively, and the patients were satisfied with their status. This newly devised continent valve construction using a bulbar urethra is effective for reconstruction of the obliterated vesicourethral junction, which markedly improves patients' quality of life.