Membranous Urethral Strictures Research Articles

Pubectomy For Repair of Membranous Urethral Strictures

We treated 7 patients with membranous urethral strictures secondary to fractures of the pelvis with pubectomy and termino-terminal anastomosis of the urethra. All patients are free of catheters and urinary tract infection. The surgical technique provided good exposure of the membranous urethra because the incision of the pubis was wide. None of the patients has had orthopedic problems secondary to the operation. Postoperative sexual function has been good.

Transpublic urethorplasty for membranous urethral strictures

Six patients with traumatic membranous urethral strictures have undergone urethroplasty utilizing the transpubic approach with resection of a wedge of the symphysis pubis. Three patients are free of stricture, 2 required urethral dilatation in the early postoperative period only, and 1 patient requires dilatation every three months. Four patients are completely continent of urine, 1 has mild stress incontinence, and 1 is incontinent because of a neurogenic bladder. This approach provides excellent exposure with minimal morbidity and allows an easy under-vision anastomosis.

Transpubic Urethroplasty

Eleven patients underwent transpubic repair of membranous urethral strictures. Excision of the wedge of pubic bone was not associated with orthopedic disability and provided excellent exposure for primary anastomosis of the urethra. Distal urethral mobilization and incision of the intercrural septum provided adequate urethral length for tension-free anastomosis. Satisfactory results were achieved in all patients, without adversely affecting continence or potency.

The Surgical Repair of Membranous Urethral Strictures in Children

Of 18 patients treated for membranous urethral strictures after rupture of the prostatomembranous urethra, 16 have had satisfactory results, 1 has been diverted permanently and the repair in 1 case is not yet complete.

Urinary Continence After Repair of Membranous Urethral Stricture in Prostatectomized Patients

Prostatectomy by open or transurethral techniques usually destroys the function of the internal sphincter (bladder neck), which is the first line of defense against incontinence. Urinary continence then depends upon the intrinsic smooth muscle sphincter of the membranous urethra and the striated external sphincter. Unfortunately, a significant incidence of membranous urethral stricture occurs after a prostatic operation. Most such strictures can be managed with periodic dilatation but some are difficult and dangerous to dilate. Complications such as recurrent acute retention, bacteremia, false passages, stone formation, fistulas and so forth are indications for surgical cure of the stricture. However, can urethroplasty of the membranous urethra be carried out in these patients without inevitable incontinence?At our center 33 prostatectomized patients have had a 2-stage urethroplasty for refractory membranous urethral strictures. Nine patients had troublesome stress incontinence after the first-stage operation but only 4 of these had continuing incontinence after the second-stage operation. These patients had been noted to have transient postoperative stress incontinence after the prostatectomy.Although there is a risk of incontinence after urethroplasty of the membranous urethra in prostatectomized patients, the risk is sufficiently low that the operation should not be denied patients with refractory strictures in whom the only alternative eventually will be some form of urinary diversion.

Turner-Warwick urethroplasty for membranous urethral stricture Revised technique

The use of extended perineal incision for both the first- and second-stage Turner-Warwick scrotal inlay urethroplasty has made this a successful procedure in the management of 22 difficult membranous and supramembranous strictures. The pliable, soft, elastic scrotal skin has produced a well-vascularized urethra which approximates closely the elastic qualities of the normal muscular urethral wall and has obviated the recurrent chronic scarred contraction that was previously experienced with the use of perineal skin. Continuing observation of the scrotal inlay with properly timed revisions before final closure has established stable stricture free lumens in patients with severely obstructed lower urinary tracts.