Abstract
URETHROPLASTY IN POSTERIOR URETHRAL INJURIES SABAH A. AI-Kadi & SAFAA A. Mohssin Department of Urology, University of Baghdad, Iraq. Abstract To assess the efficacy of urethroplasy (excision with end to end anastomosis) in posterior urethral injuries. Fifteen patients with complete urethra! disruption were treated by this method and followed with objectives and subjectives parameters for 2 years. The results are graded into 3 grades (excellent, satisfactory and poor) according to continence and flow rate of urine, 80% of cases have stricture (>2 cm) in length. Those patients who are treated with perineal approach result in (92%) excellent, in comparison to those with transpubic urethroplasty who give only (50%) excellent results. Patients with no history of urethral handling give (100%) excellent results, while only (25%) excellent results in patients with previous urethral surgical intervention. Urethroplasty is the best method for repairing completely obliterated strictures. Intraoperative endoscopic checking of posterior urethra is important to avoid fistulous tracts. Dilatation and urethrotomy may be used as complementary procedures to urethroplasty. Pubectomy sometimes necessary in complicated cases.
Highlights
Trauma is a major cause of urethral disruption and stricture in the posterior urethra
Posterior urethral stricture with completely obliterated lumen treated by methods other than urethroplasty has a high recurrence and or failure rates
Those patients without history of urethral handling did better than those with previous history of urethral handling. This is in accordance with other series since more fibrosis is induced with each intervention[7,8,9,10,11]
Summary
Trauma is a major cause of urethral disruption and stricture in the posterior urethra. Disruption of the prostato-membranous urethra occurs in approximately (10%) of the patients with pelvic fractures, such injuries usually end up with stricture formation. Submucosal scars, has little effect on the diameter of the lumen, while dense scarring in the corpus spongiosum produces marked contracture of the lumen. It has been established that the urethra is capable of regenerating all its components including the corpus spongiosum[3] if a narrow strip was left intact. Urethroplasty is one of the methods of treatment of urethral strictures. It is best suited for cases with complete disruption or after multiple failed urethrotomies and in complicated strictures (e.g. coexistent fistula, Etc.)[4]. Urethroplasty could be done by (regeneration, substitution, and excision with spatulated, tension free, end to end anastomosis), the last is the only procedure with long term success rate approximating 100%5'6
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