Modified Urethral Pull-Through Operation for Posterior Urethral Stricture and Long-Term Outcome

Abstract

We present our experience, technique and long-term results of the modified urethral pull-through operation for posttraumatic posterior urethral stricture. A total of 113 patients with posttraumatic posterior urethral stricture resulting from pelvic fracture injury underwent the modified urethral pull-through operation at our department from August 1999 to March 2007. Patient age was 17 to 69 years (mean 35.2). Stricture length was 1.5 to 4.7 cm (mean 2.6). Of the patients 52 (46.0%) had undergone at least 1 previous failed management for stricture, including urethroplasty in 29 (25.7%). Followup included symptomatic and urinary flow rate evaluation, which was performed 6 and 12 months after the modified urethral pull-through operation in all patients and thereafter when needed, and urethrography and/or urethroscopy in patients with voiding symptoms. Clinical outcomes were considered a success when no postoperative procedure was needed. Patients were followed for 12 to 86 months (mean 48.5). During that period 109 patients were symptom-free and required no further procedures. The maximal flow rate in each case was greater than 15 ml per second. Recurrent stricture developed in 4 patients. All treatment failures occurred within the first 8 months postoperatively. Failed repairs were successfully managed endoscopically in 1 patient by urethral dilation in 1 and by repeating the pull-through operation in the remaining 2 for a primary success rate of 96.5% and a final success rate of 100%. All patients were continent. Erectile dysfunction was noted postoperatively in 5 patients (3.7%). There was no chordee, penile shortening or urethral diverticula. The modified urethral pull-through operation is effective for the surgical treatment of posttraumatic posterior urethral stricture. It has a high success rate with durable long-term results. Complications are few. The procedure is simple, less demanding and especially suitable in patients who had previously undergone failed surgical treatments.