Anastomotic urethroplasty for failed previously treated membranous urethral rupture

Abstract

Objectives To determine whether delayed excision and primary anastomosis is appropriate after failed previous therapeutic attempts for post-traumatic membranous urethral strictures. Delayed excision and primary anastomosis is widely accepted as the first-line treatment of post-traumatic membranous urethral strictures. Methods A review of the medical records identified 13 patients who had undergone anastomotic urethroplasty as a second procedure for traumatic membranous urethral strictures. The previous treatments in these patients included anastomotic urethroplasty in four, staged urethroplasty in four, and endoscopic urethrotomy or primary catheter realignment in five. The mean stricture length was 2.8 cm. All patients underwent excision and primary bulboprostatic anastomosis using the perineal approach. Results Four patients required partial pubectomy and one required corporal rerouting to achieve anastomosis. The mean follow-up was 27 months. Urethrography performed 1 month postoperatively demonstrated a widely patent anastomosis in all cases. Flexible urethroscopy performed 1 year after surgery revealed a widely patent anastomosis with normal urethral mucosa in all patients but one. The mean maximal flow rate at the last follow-up visit was 23.5 mL/s compared with 3.9 mL/s preoperatively. No statistically significant postvoid residual urine volume was found in any patient. One patient developed an anastomotic stricture 3 months after surgery that was treated successfully by internal urethrotomy. Thus, the objective success rate was 92%. Subjectively, all patients but one reported satisfactory voiding. Complications were mild and included urinary tract infection, bladder stone formation, and decreased erectile function in 1 patient each. Conclusions Even in patients with failed previous surgical attempts, excision and primary anastomosis is feasible and provides good surgical results in post-traumatic posterior urethral strictures. The complications were mild and easily treated.