English

Abstract

PURPOSE: To identify and study various factors and complications that crop up in post- operative period and pose a challenge to the treating urologist in providing a satisfactory outcome to patients. MATERIAL AND METHODS: 240 patients who underwent urethroplasty were included in this study. Patients were followed up postoperatively at 6 week and 6 month. The retrospective arm was used as experience and existing complications were taken as challenge for improvising urethroplasty skills in management of urethral stricture secondary to PFUDD. RESULTS: majority of the patients were of reproductive age group, with bulb membranous junction as the most common location. Of all about 60% had TILE A grade of pelvic fractures, 27% had TILE B and 13% with TILE C. at 6 week follow up post urethroplasty none of the patient had recurrence of the stricture, 15 (6.25%) had erectile dysfunction and 5 (2.08%) patients presented with the complications of the urinary incontinence. At 6 month follow up after urethroplasty 15(6.25%) patients developed recurrence of stricture 5 out of 15 who presented with erectile dysfunction showed improvement In a review of 60 cases of anastomotic urethroplasty for PFUDD, Corriere describes both early and late complications. Surgical complications included rectal injuries (3%), repeat strictures that required dilation or visual internal urethrotomy (32%), and repeat strictures that required reoperation (5%). By 1 year after surgery, all patients had a patent urethra (100%). At 1 year, 43 (72%) patients voided normally, 5(8.3%) were areflexic and performed self-catheterization, 5 (8.3%) had urge incontinence, and 5(8.3%) had mild stress incontinence requiring no treatment. Moderate stress incontinence responded to imipramine in one case and collagen injection in one. The risk of incontinence due to sphincter weakness following anastomotic urethroplasty is very low as continence depends on the intact bladder neck. 6 Open bladder neck seen cystoscopy and/or cystography before urethroplasty may herald postoperative incontinence. 7 At present; the preferred option is to manage the PFUDD and bladder neck problem sequentially. Bladder neck reconstruction provides good postoperative continence rates, although some patients may require a sling procedure or implantation of an artificial urinary sphincter. 8 Of the patients who were potent preoperatively only 52% remained potent postoperatively.