Re: challenging non-traumatic posterior urethral strictures treated with urethroplasty: a preliminary report

João P M De Carvalho

doi:10.1590/s1677-55382009000500013

Abstract

Introduction: Posterior urethral strictures after prostatic radiotherapy or surgery for benign prostatic hyperplasia (BPH) refractory to minimal invasive procedures (dilation and/or endoscopic urethrotomy) are challenging to treat. Published reports of alternative curative management are extremely rare. This is a preliminary report on the treatment of these difficult strictures by urethroplasty. Materials and Methods: Seven cases were treated: 4 cases occurred after open prostatectomy or transurethral resection of the prostate for BPH, one case after external beam irradiation and 2 after brachytherapy. The 4 cases after BPH-related surgery were in fact complete obstructions at the bladder neck and the membranous urethra with the prostatic urethra still partially patent. Anastomotic repair by perineal route was done in all cases with bladder neck incision in the BPH-cases and prostatic apex resection in the radiotherapy cases. Results: Mean follow-up was 31 months (range: 12-72 months). The operation was successful, with preserved continence, in 3 of the 4 BPH-cases and in 2 of the 3 radiotherapy cases. An endoscopic incision was able to treat a short re-stricture in the BPH-patient and a longer stricture at the bulbar urethra could be managed with a perineostomy in the radiotherapy-patient. Conclusion: Posterior non-traumatic strictures refractory to minimal invasive procedures (dilation/endoscopic urethrotomy) can be treated by urethroplasty using an anastomotic repair with a bladder neck incision if necessary.

Highlights

To the Editor, This interesting paper raises some theories about urethral stricture, its ongoing process, and how to deal with challenging cases
While urethroplasty was performed on macroscopically healthy ends, there is no histological confirmation of whether the urethral margin tissue is free from fibrosis, which has been suggested by some authors to be one of the most important aspects to be used when performing endto-end anastomosis [1,2,3]
Urodynamics studies would confirm the damage of the external sphincter after urethroplasty

Summary

Introduction

To the Editor, This interesting paper raises some theories about urethral stricture, its ongoing process, and how to deal with challenging cases. Only a small number of patients were observed, this fact does not compromise the results, as the incidence of this specific pathology is very low. While urethroplasty was performed on macroscopically healthy ends, there is no histological confirmation of whether the urethral margin tissue is free from fibrosis, which has been suggested by some authors to be one of the most important aspects to be used when performing endto-end anastomosis [1,2,3].

Results

Conclusion