Post-traumatic Urethral Strictures Research Articles

Optic Internal Urethrotomy Under Transrectal Ultrasonographic Guide And Suprapubic Fiberoscopic Aid

Optic internal urethrotomy is the initial treatment of choice for most urethral strictures because of the relatively low morbidity and ease of accomplishment. However, the procedure is difficult and frustrating if a severe stricture or complete disruption of the urethra is encountered. Transrectal ultrasonography of the urethra offers good anatomical visualization, and defines the exact length and extent of bulbous and posterior urethral strictures, which could ensure a more accurate and aggressive incision of the stricture. Eleven patients (8 with posttraumatic and 3 with iatrogenic strictures) with complete obliteration of the bulbous and posterior urethra were successfully treated by optic internal urethrotomy with the aid of transrectal ultrasonography and a suprapubic fiberscope. After 1 year of followup, 5 of the 8 posttraumatic urethral strictures required further management, while the remaining patients had satisfactory results. Although the recurrence rate is high in the posttraumatic patients, transrectal ultrasound and the suprapubic fiberoscope afford a reliable and satisfactory aid during optic internal urethrotomy.

Lower urinary and genital tract trauma

One of the most important advances in trauma to the lower urinary and genital tracts has been the increased use of imaging techniques in its diagnosis and treatment. Computed tomography has been used in the diagnosis of bladder rupture and magnetic resonance imaging and ultrasonography in the diagnosis of post-traumatic urethral strictures. The treatment of post-traumatic urethral strictures by endoscopic urethroplasty has been facilitated by ultrasonography and fluoroscopy and ultrasonography has helped with blunt testicular injury in deciding surgery or observation.

Cystoscopic transvesical placement of sutures for repair of posterior urethral strictures

Successful repair of post-traumatic posterior urethral strictures can be accomplished in several ways, and careful patient selection is of utmost importance. The two most important selection factors to consider are the length of the stricture or the gap that must be bridged and whether or not the anterior urethra has been damaged. If the anterior urethra is undamaged, it, being an elastic structure, can be mobilized and used to bridge the gap. If the anterior urethra is damaged or the gap to be bridged is greater than 1.5 cm, some form of skin substitution urethroplasty should be used.’ The two main types are the posteriorly based flap of perineal or perineoscrotal skin and the scrotal “drop back” technique.2 The primary rule of urethroplasty is complete excision of all scar and reapproximation of normal urethra to normal urethra or skin substitution inlay that extends into at least 2-3 cm of overtly normal urethra.2 This frequently requires placement of sutures deep in the perineum, occasionally extending across the sphincter and into the prostatic urethra itself. Proper placement of these sutures is critical and can be difficult even when using the special curved needles and other instruments developed by Turner-Warwick.2 In difficult cases involving a small patient or an exceedingly narrow pelvis, we have simplified placement of these deep sutures by utilizing the suprapubic cystotomy tract. The loaded urethroplasty needle is passed alongside the cystoscope through the tract. The tip of the scope is passed through the bladder neck into the prostatic urethra, and the stitch is placed under direct vision in the distal prostatic urethra (Fig. 1). Proper placement and a secure “bite” are assured. An assistant grasps the suture from below under direct vision and secures Sumawbic

Use of the Flexible Fiberoptic Nephroscope in the Preoperative Evaluation and Delayed Repair of Traumatic Urethral Strictures

A flexible, fiberoptic nephroscope was used in the preoperative evaluation and subsequent repair of obliterative, post-traumatic urethral strictures in 2 men. Antegrade passage of the flexible nephroscope through a previously established suprapubic cystostomy tract afforded direct visualization of the bladder neck and uninvolved urethra proximal to the strictures. Thereby, precise definition of involvement of the membranous urethra and striated external sphincter was established. This facilitated selection between transperineal and transpubic operative approaches as well as intraoperative localization of the proximal margins of the strictures.