Transpubic Urethroplasty for Complex Posterior Urethral Strictures: A Single Center Experience

Abstract

Aim: To review our experience and outcome of transpubic urethroplasty for complex posterior urethral strictures. Patients and Methods: 19 patients, mean age 17.8 (6–35) years, were treated with transpubic urethroplasty over the last 6 years. All had traumatic etiology (15 due to road traffic accidents and 4 due to falls from height). Mean stricture length was 4.4 (3.0–6.0) cm. All had a history of some intervention earlier. Three had rectourethral fistula, and 2 sinus tract in perineum which was connected to the periurethral cavity. One had a long fistulous tract connected through the anus to the anterior abdominal wall. One patient each had urethrocutaneous fistula, periurethral cavity and osteomyelitis of the pubic bone. Results: 16 of 19 (84.2%) patients had excellent outcomes with no evidence of stricture. Three had acceptable outcomes with some evidence of stricture. The mean operative time was 3.2 (2.5–4.0) h and average blood loss was 650 (500–900) ml. The mean hospital stay was 7.6 (6–12) days and average follow-up was 30 (7–66) months. Two patients developed mild wound infection. One patient each developed epididymoorchitis, perineal hematoma, fecal fistula and urine leak. One patient failed to void, and one patient developed erectile dysfunction. Conclusion: Transpubic urethroplasty is an excellent approach for patients with complex posterior urethral strictures.