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      Posterior Urethral Strictures

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      Author(s): , *
      Publication date (Electronic):
      Journal: Advances in Urology
      Publisher: Hindawi Publishing Corporation

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          Abstract

          Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty.

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          Non-transecting anastomotic bulbar urethroplasty: a preliminary report.

          Jürgen Andrich, William R Mundy (2012)
          To report our early experience with a novel approach to the excision and end-to-end anastomotic repair of bulbar urethral strictures. A total of 22 patients underwent excision and end-to-end anastomosis of a proximal bulbar urethral stricture using a technique in which the corpus spongiosum is not transected, so as to maintain its blood supply intact. The range of follow-up was 6-21 months and for 16 patients the follow up was ≥1 year. At 1 year of follow-up there was no evidence of a recurrent stricture on symptomatic assessment or uroflowmetry in the 16 patients. On urethrography one patient has a urethral calibre 80% of normal. In the other 15 the calibre is normal or greater than normal. The non-transecting anastomotic bulbar urethroplasty technique used appears to give results that are as good as those of traditional anastomotic urethroplasty with less surgical trauma. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.
          Article 0 comments Cited 34 times – based on 0 reviews     Review now
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            Urethral reconstruction for traumatic posterior urethral disruption: outcomes of a 25-year experience.

            Matthew Cooperberg, Jack McAninch, Nejd Alsikafi … (2007)
            Management of posterior urethral disruption due to pelvic trauma can be quite challenging and is the subject of ongoing controversy. This study presents an update of the University of California, San Francisco experience with delayed anastomotic posterior urethroplasty for management of these injuries. Since 1979 all patients undergoing posterior urethroplasty by a single surgeon at University of California, San Francisco and its affiliated hospitals have been entered prospectively into a patient registry. For this cohort descriptive statistics were calculated and recurrence was analyzed with the Kaplan-Meier method. Success was defined as no recurrence (by symptoms and/or retrograde urethrogram) or a mild recurrence managed successfully with a single internal urethrotomy. A total of 134 male patients were analyzed with a mean of 32.9 and a median of 12 months followup. Mean patient age at surgery was 34.8 years. Of the patients 35% had undergone at least 1 prior procedure for stricture including prior urethroplasty in 16%. In addition, 22% required partial pubectomy and 4% a combined abdominal-perineal approach with total pubectomy. Of patients with a closed bladder neck on urethrography 34% vs 7% of those with an open bladder neck required pubectomy (p <0.001). Stricture length tended to be longer in pubectomy cases (mean 3.2 vs 2.1 cm by urethrography, p = 0.055). Of the patients 14% experienced recurrent stricture at a mean of 12 months, 42% of whom were treated successfully with a single urethrotomy. The overall success rate allowing 1 direct vision internal urethrotomy was 93%. Anastomotic urethroplasty offers excellent long-term results to patients with posterior urethral trauma and stricture disease even after multiple prior procedures.
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              On the art of anastomotic posterior urethroplasty: a 27-year experience.

              Mamdouh M. Koraitim (2004)
              We determined the various operative details of anastomotic posterior urethroplasty that are essential for a successful result. We reviewed the medical records of 155 patients who had undergone anastomotic repair of posterior urethral strictures or distraction defects between 1977 and 2003. Patient age ranged from 3 to 58 years (mean 21) and all except 1 had sustained a pelvic fracture urethral injury as the initial causative trauma. Repair was performed with a perineal procedure in 113 patients, elaborated perineal in 2 and perineo-abdominal in 40. Followup ranged from 1 to 22 years. The results were successful in 104 (90%) cases after perineal (including 2 elaborated perineal) and in 39 (98%) after perineo-abdominal repair. Successful results were sustained for up to 22 years after surgery. Urinary incontinence did not develop in any patients while 2 lost potency as a direct result of anastomotic surgery. Of the operative details 3 constitute the gold triad that assures a successful outcome, namely complete excision of scarred tissues, fixation of healthy mucosa of the 2 urethral ends and creation of a tension-free anastomosis. When the bulboprostatic urethral gap is 2.5 cm or less, restoration of urethral continuity may be accomplished with a perineal procedure after liberal mobilization of the bulbar urethra. For defects of 2.5 cm or greater the elaborated perineal or perineo-abdominal transpubic procedure should be used. In the presence of a competent bladder neck, anastomotic surgery does not result in urinary incontinence. Impotence is usually related to the original trauma and rarely (2%) to urethroplasty itself.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Adv Urol
                Journal ID (iso-abbrev): Adv Urol
                Journal ID (publisher-id): AU
                Title: Advances in Urology
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 1687-6369
                ISSN (Electronic): 1687-6377
                Publication date (Print): 2015
                Publication date (Electronic): 24 November 2015
                Volume: 2015
                Electronic Location Identifier: 628107
                Affiliations
                University of California, Irvine, 333 City Boulevard West, Suite 1240, Orange, CA 92868, USA
                Author notes

                Academic Editor: Francisco E. Martins

                Article
                DOI: 10.1155/2015/628107
                PMC ID: 4672120
                PubMed ID: 26691883
                SO-VID: 15a678d0-10c9-4cfe-8d03-fe30b049314f
                Copyright © Copyright © 2015 J. Gelman and E. S. Wisenbaugh.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 8 October 2015
                Date accepted : 2 November 2015
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Urology
                Data availability:
                ScienceOpen disciplines: Urology

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