On the Art of Anastomotic Posterior Urethroplasty: A 27-Year Experience

Abstract

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.

Comprehensive analysis of etiology on the prognosis of urethral strictures

“…A similar trend was evident in post traumatic strictures in the present study. Furthermore, the results were much better in Numerous studies support the occurrence of complications after urethral injury following a pelvic fracture, due to the injury itself rather than the surgical technique (14)(15)(16). We encountered complications in 26 patients with post traumatic strictures: infection, re-stenosis, impotence, urinary incontinence, urethracutaneous fistulae, wound dehiscence and ejaculatory disturbances, with rates acceptable in comparison to other studies (17,18).…”

Evaluation of erectile function after urethral reconstruction: a prospective study

“…In this procedure, the number of patients with impotence according to the IIEF-5 criteria was similar to the number of those without impotence. We did not expect any change in erectile function in those who underwent the end-to-end anastomosis, as Koraitim [13] suggest that impotence is usually related to the original trauma and rarely (2%) to urethroplasty itself. Furthermore, no patient reported a decline in erectile function after end-to-end anastomosis in a study by Barbagli et al [14].…”

Posterior urethroplasty: indications and results, a six years’ experience from two teaching hospitals in Iraq

“…However, in rate cases of female urethral distraction injury, some authors have suggested immediate open realignment to avoid subsequent urethravaginal fistulae or urethral stricture. 1 Endoscopc procedures, such as cutting a tunnel between the two ends of the avulsed urethra (cut-to the light procedure), can have unacceptable failure and complication rates, including coring of false passage that inadvertently bypasses the bladder neck. Pro-operative MRI, prior to perineal urethroplasty, is deemed necessary by some authors, since it can reveal the presence of associated corporal rupture, corporal body avulsion, and significant ischial fractures that may interfere with perineal repair.…”

“…Suprapubic drainage is maintained until associated injuries have healed and the patient can be places appropriately for the reconstructive procedure which my take from 3 to 12 months. 1 At three months, the resulting hematoma resolves and scar tissues at the injury site become stable (complete fibrosis) complete ambulation of the patient. At this stage, perianal urethroplasty comes into play, especially with long strictures.…”

“…2 Internal optical urethrotomy is also recommended in short strictures that are the sequelae of a distraction injury for which early catheterization resulting in urethral continuity was possible. 1 And as such, author notice that the management of urethral stricture runs in a "stepwise ladder fashion" (if one may say), shifting to the higher step in case the previous one fails or starting from that higher step initially. 2 On the top of this ladder is the open perineal urethroplasty (end-toend anastomosis), which is reserved for long urethral strictures (>2cm in length).…”