Posterior Urethroplasty Research Articles

Assessment and Management of an Open Bladder Neck at Posterior Urethroplasty

To determine the factors that may influence the risk of injury to the bladder neck in patients sustaining a pelvic fracture urethral injury and report our experience in the management of an open bladder neck at the time of delayed repair. We identified 21 patients with an open bladder neck on cystography before they underwent repair of a pelvic fracture urethral distraction defect. Of these patients, 12 were continent after urethroplasty and 9 received bladder neck reconstruction concomitant with or subsequent to urethroplasty. Bladder neck reconstruction was performed by Young-Dees-Leadbetter (5) or anterior bladder flap-tube (4) procedure. Patients with an incompetent bladder neck were usually (67%) children <or=15 years old, had been most commonly (75%) managed initially by primary realignment, and all (100%) had fracture of ipsilateral ischiopubic rami. The preoperative cystogram showed a bladder neck opening of a rectangular shape, and suprapubic cystoscopy revealed a fixedly open bladder neck. Of the 9 patients who received a bladder neck reconstruction, 7 (78%) had a successful outcome and 2 (22%) had a treatment failure. It seems that the risk of injury to the bladder neck increases in children, in ipsilateral ischiopubic rami fracture and in cases managed initially by primary realignment. At posterior urethroplasty, the presence of an incompetent bladder neck is suspected by the finding of an open bladder neck of a rectangular shape on cystography and a fixedly open bladder neck on suprapubic cystoscopy. Reconstruction of the bladder neck by Young-Dees-Leadbetter procedure probably offers the best successful results.

Posterior Urethral Stricture After Pelvic Fracture Urethral Distraction Defects in Developing and Developed Countries, and Choice of Surgical Technique

We compared posterior urethral strictures after pelvic fracture urethral distraction defects in India and Italy. We retrospectively analyzed the records of patients in India and Italy who underwent repair for posterior urethral stricture after pelvic fracture urethral distraction defect. We investigated etiology, emergency treatment type, the specialist involved in emergency treatment, the type of stricture resulting from trauma and primary repair, posterior urethroplasty techniques and results. Of 255 patients with a median age of 33 years 117 (45.8%) and 138 (54.2%) were evaluated in India and Italy, respectively. In India the most common causes of pelvic fracture urethral distraction defects were pedestrian (35%), motorcycle (26.5%) and bicycle (12.8%) accidents. The most common emergency treatment was suprapubic cystostomy (79.5% of cases). Of the patients 70.1% were treated in emergency fashion by a surgeon and 85.4% had complex posterior urethral strictures. The most common technique was anastomosis with inferior and total pubectomy in 56.4% and 15.3% of cases, respectively. In Italy the etiology was mainly automobile accidents (39.2%). The most common emergency treatment was endoscopic realignment (49.2% of cases). Of the patients 92.7% were treated in emergency fashion by a urologist and 68.1% had simple urethral strictures. Perineal anastomosis and laser urethrotomy were the most used techniques (38.4% and 21.1% of cases, respectively). In India 92 cases (78.6%) were successful and 25 (21.4%) failed while in Italy 120 (86.9%) were successful and 18 (13.1%) failed. Median followup was 74 months (range 12 to 239). Differences in emergency treatment for pelvic fracture urethral distraction defects influence the choice of delayed posterior repair and results.

Editorial Comment

This is a stunningly large series of urethral distraction injuries repaired at 1 referral center. It is a welcome analysis, and provides insight into several important questions. (1) The success rate of redo perineal urethroplasty: the success rate of second urethroplasty is 83% compared with 90% in unoperated cases. (2) Timing of failures: most failures occur before 6 months. (3) Complication rate: in this series, there was new impotence in 12% of cases (not reported in other series). (4) Higher failures in children: this series confirms that children have a 7% higher failure rate than adults. There are some other conclusions, however, that are less robust, and deserving of some unwincing examination. Transperineal Bulboprostatic Anastomosis in Patients With Simple Traumatic Posterior Urethral Strictures: A Retrospective Study from a Referral Urethral CenterUrologyVol. 74Issue 5PreviewTo evaluate the results of ancillary procedures for posterior urethroplasty and compare them with the severity of urethral stricture. Full-Text PDF ReplyUrologyVol. 74Issue 5PreviewThis is an interesting issue for discussion. First, we will discuss urethral lengthening. It may be unusual for specialists to require maneuvers such as corporeal rerouting or pubectomy. We also suggest distal mobilization of the bulbar urethra from the external sphincter to the penoscrotal junction, because this is known to provide 4-5 cm of the urethral length. This step alone should be sufficient to allow tension-free anastomosis in most patients, because in 76%-78% of patients the defect was < 3 cm. Full-Text PDF

Leaving No Stone Unturned

Leaving No Stone Unturned

Erectile function after posterior urethroplasty for pelvic fracture‐urethral distraction defect injuries

To determine the specific effect of pelvic fracture-urethral distraction defect (PFUDD) injuries on erectile function (EF) in men after pelvic fractures, and to compare EF to that found in other studies of men who sustained pelvic fractures, as currently the relationship between erectile dysfunction (ED) and PFUDD has not been elucidated using validated questionnaires. With approval from the institutional review board, patients who sustained a PFUDD injury and had a posterior urethroplasty from 1990 to 2004 were identified from a database. Patients were contacted by telephone, and those who were willing to participate were given the International Index of Erectile Function (IIEF) questionnaire. Using unpaired Student's t-tests, IIEF scores were compared to normal controls, and to results of other studies of men sustaining pelvic fractures. In all, 26 men completed the IIEF, among whom EF was compromised in 14 (54%), including eight with severe ED (31%). Orgasmic function and ejaculation was maintained. Men with a PFUDD had significantly worse EF than men in other series with pelvic fractures. Men who sustain a PFUDD are at significantly greater risk of ED than those with no urethral distraction injury. Men with PFUDD injuries represent a target population for early penile rehabilitation programmes.

Transperineal Bulboprostatic Anastomosis in Patients With Simple Traumatic Posterior Urethral Strictures: A Retrospective Study from a Referral Urethral Center

To evaluate the results of ancillary procedures for posterior urethroplasty and compare them with the severity of urethral stricture. A total of 301 patients (average age: 36 years) with posterior urethral strictures due to pelvic fracture urethral distraction defects were included in the study. Delayed transperineal bulboprostatic anastomosis was performed 6-24 months (mean 10 months) after pelvic fracture urethral distraction defects. Simple perineal anastomosis: 103 (34.2%) patients (group 1); perineal anastomosis with separation of the corporeal bodies: 89 (29.6%) patients (group 2); perineal anastomosis with inferior pubectomy: 95 (31.6%) patients (group 3); perineal anastomosis with rerouting of the urethra around the corpora cavernosum: 14 (4.7%) patients (group 4). The clinical outcome was considered a failure when any postoperative instrumentation was needed. The primary outcome examined the total success rate of the procedures. The secondary outcome examined the success rate of the procedures according to the ancillary surgical steps. Of the 301 delayed transperineal bulboprostatic anastomosis procedures, 263 (87.4%) were successful and 38 (12.6%) were unsuccessful. Simple perineal anastomosis without ancillary procedures reflected an 89.3% success rate, perineal anastomosis with separation of the corporeal body had an 86.5% success rate, perineal anastomosis with inferior pubectomy had an 84.2% success rate, and perineal anastomosis with urethral rerouting had an 85.7% success rate. Corporal splitting, inferior pubectomy, and urethral rerouting are beneficial and useful ancillary procedures in transperineal posterior urethroplasty to achieve tension-free anastomosis.

Clinical Outcome and Quality of Life Assessment in Patients Treated With Perineal Urethrostomy for Anterior Urethral Stricture Disease

We performed a quality of life assessment for patients treated with perineal urethrostomy for anterior urethral stricture disease. We retrospectively reviewed 173 patients (median age 55 years) who underwent perineal urethrostomy (from 1978 to 2007) as part of a plan for a staged urethroplasty repair for a complex anterior urethral stricture. The perineostomy was made using flap urethroplasty. The clinical outcome was considered a failure when postoperative instrumentation was needed. A questionnaire was used to evaluate patient quality of life and satisfaction. Stricture etiology was unknown in 50.3% of the cases, lichen sclerosus in 17.3%, catheter in 13.3%, instrumentation in 8.7%, failed hypospadias repair in 4.6%, trauma in 4.1% and infection in 1.7%. Stricture length was 1 to less than 2 cm in 1.2% of cases, 2 to less than 3 cm in 3.5%, 3 to less than 4 cm in 12.1%, 4 to less than 5 cm in 13.8%, 5 to less than 6 cm in 7.5%, greater than 6 cm in 4.1% and panurethral in 57.8%. Of 173 patients 91 (52.6%) underwent prior urethroplasty. Median followup length was 62 months (range 12 to 361). Of 173 cases 121 (70%) were successful and 52 (30%) were failures, requiring revision of the perineostomy. Of 173 patients 135 (78%) were satisfied with the results obtained with surgery, 33 (19.1%) were very satisfied, 127 (73.4%) with a median age of 57 years (range 23 to 85) refused to do the second stage of urethroplasty and 46 (26.6%) with a median age of 47.5 years (range 27 to 72) are currently on a waiting list for the second stage of urethroplasty. Perineostomy is a necessary procedure for patients with complex urethral pathology and satisfaction rates are high.

The Use oF Flexible Cystoscope in Posterior Urethroplasty

We present our experience with a simplified anastomotic posterior urethroplasty to highlight the necessity and usefulness of ancillary reconstructive maneuvers. We reviewed the records of 46 patients who had undergone anastomotic repair of posterior urethral strictures due to pelvic trauma between 2000 and 2007. Mean patient age at surgery was 43 years. Average stricture length was 2.3 cm. Repair was performed with a progressive perineal anastomotic procedure using flexible cystoscope by means of transcystostomic approach: after mobilization of the bulbo-membranous urethra and the corporal splitting, the prostatic apex is well visualized and the membranous urethra is sectioned proximally; the flexible cystoscope by means of transcystostomic approach facilitates to find the proximal urethral lumen and to perform the bulbo-prostatic anastomosis. Mean follow-up was 32 months. Of 46 cases, 40 (87 %) were successful and 6 (13 %) failed with recurrence of the stricture. Urinary incontinence did not develop in any patients. The operative details and maneuvers facilitate the preparation of the bulbo-membranous urethral tract and prostatic apex, and simplify the performance of the anastomotic repair.

Management of posterior urethral disruption injuries

Posterior urethral disruption is a traumatic injury to the male urethra, which most often results from pelvic fracture. After trauma, the distraction defect between the two ends of the urethra often scars and becomes fibrotic, blocking the urethra and bladder emptying. Increasing evidence suggests that many posterior urethral disruptions occur at the junction between the membranous urethra and the bulbar urethra, which is distal to the rhabdosphincter. In the acute setting, when a posterior urethral disruption is suspected, retrograde urethrography should be performed. Posterior urethral disruptions can be managed acutely by realignment of the urethra over a urethral catheter or by placement of a suprapubic catheter for bladder drainage only. Once fibrosis has stabilized, the patient can undergo posterior urethroplasty. In most cases, this procedure can be performed via a perineal approach in a single-stage surgery. The results of this single-stage perineal urethroplasty are excellent, and a patent urethra can be re-established in the majority of men who undergo surgery.

Surgical repair of posterior urethral defects: review of literature and presentation of experiences.

The main objective of the present review article was to study the different aspects of reconstructive surgery for posterior urethral defects by reviewing the published articles and presentation of our experiences in the reconstructive urology division at Shohada-e-Tajrish hospital. The Medline was searched with the keywords of posterior urethroplasty, end-to-end anastomosis, excisional urethroplasty, anastomotic urethroplasty, pelvic fracture, bulboprostatic anastomosis, and urethral repair. The search was limited to papers published from 1980 to September 2008. We selected the relevant published articles in this database and also presented our experience at our reconstructive urology division. Of over 5000 search results, we selected 38 relevant articles with substantial contribution to the subject. Pelvic fracture due to accidents was the most common etiology of pelvic fracture urethral distraction defect that usually involved the membranous urethra. Surgical treatment of this disorder with perineal anastomotic urethroplasty was accompanied by a success rate of 82% to 95% in different studies. The most important complications of this surgery include urinary incontinence and impotence; however, the incidence of these complications has been reduced by using new surgical techniques. Complete preoperative assessment, the use of suitable reconstructive techniques, and in particular, the use of flexible cystoscopy can lead to acceptable outcomes of the surgical repair of pelvic fracture urethral distraction defects.

Ejaculatory profiles and fertility in men after posterior urethroplasty for pelvic fracture‐urethral distraction defect injuries

In men who sustain a pelvic fracture-urethral distraction defect (PFUDD) injury, repairing the urethra involves a complicated urethral anastomosis located posteriorly at the junction of the membranous and prostatic urethra. In this study we performed a post- operative semen analysis and questionnaire study to determine the effect of PFUDD injuries and PFUDD repair on ejaculatory function and fertility in these men. With institutional review board approval, patients who had PFUDD repairs by one surgeon from 1990 to 2004 were identified from a database. Patients were contacted and given a questionnaire eliciting details about their ejaculatory function and history of fertility. Those interested in future paternity were asked to provide semen for analysis. In all, 32 men were contacted; all claimed to have antegrade ejaculation, although five reported having a lower ejaculatory volume than before their injury, and one claimed that his ejaculate was delayed. We assessed fertility in 19 men, six of whom had either infertility or abnormal semen analyses. All men in the present series who had PFUDD injuries repaired had antegrade ejaculation. Although six of 19 had either infertility or an abnormal semen analysis, it appears that the risk of damage to the ejaculatory ducts from either a PFUDD or the subsequent urethral reconstruction is low. However, other associated injuries at the time of the pelvic fracture might place these men at greater risk of infertility.

Transpubic Posterior Urethroplasty via Perineal Approach in Children : A New Technique

PURPOSE Is to evaluate a new the technique of transpubic urethroplasty via perineal approach for managment of pelvic fracture urethral distraction defect (PFUDD) in children. MATERIAL AND METHODS A prospective study was performed on 52 children undergoing posterior urethroplasty for pelvic fracture urethral distraction defect. After perineal midline approach and excision of all fibrous tissues , 6 out of 52 children had a short urethra that could not bridge the gap (more than 5 cm) to do tension free anastomosis . For the latter group ,transpubic posterior urethroplasty via perineal approach was performed. Firstly, the upper border of the symphysis pubis was palpated and the corporal separation was done distally till this level (peno-scrotal junction). Dissection of one crus started from Medial to lateral edge. After complete separation from the bone, the same was done for the other crus. Two crura was hold laterally with tape and two longitudinal lines were performed over the pubic bone, the distance in between about 4 cm. By cutting diathermy over theses lines, separation of the pubic bone from lateral attachment was performed. The separated bone was hold by nipple forceps and complete separation from the bladder was done by cutting diathermy. Easy bulbo-prostatic anastomosis was performed. RESULTS All six children had a good urinary stream without any post-operative complication related to the technique. CONCLUSIONS Transpubic urethroplasty via perineal approach in children is a feasible easy technique with very minimal morbidity and can be done safely in children when indicated. Easy Bulbo-prostatic anastomosis can be done through the perineal exposure.

TRANSPUBIC POSTERIOR URETHROPLASTY VIA PERINEAL APPROACH IN CHILDREN: A NEW TECHNIQUE

You have accessJournal of Urology1 Apr 2008TRANSPUBIC POSTERIOR URETHROPLASTY VIA PERINEAL APPROACH IN CHILDREN: A NEW TECHNIQUE Samir S Orabi Samir S OrabiSamir S Orabi More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)60039-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "TRANSPUBIC POSTERIOR URETHROPLASTY VIA PERINEAL APPROACH IN CHILDREN: A NEW TECHNIQUE." The Journal of Urology, 179(4S), p. 12 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 12 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Samir S Orabi More articles by this author Expand All Advertisement PDF downloadLoading ...

Gapometry and Anterior Urethrometry in the Repair of Posterior Urethral Defects

We determined the influence of bulbar urethral length on the anastomotic repair approach to bulboprostatic urethral distraction defects. We reviewed the medical records and radiographic studies of 120 patients 6 to 52 years old who had undergone anastomotic repair of bulboprostatic urethral gaps. Repair was accomplished by a simple perineal operation in 84 patients (group 1) and an elaborated perineal or a transpubic procedure in 36 (group 2). The length of the urethral gap and bulbar urethra was measured on preoperative urethrogram. Also, the length of the urethral gap as a fraction of bulbar urethral length (index of elastic lengthening) was calculated. Mean length of the urethral gap was 1.5 cm in group 1 vs 4.2 cm in group 2 (p <0.001). Mean bulbar urethral length was 7.3 cm in group 1 vs 6.6 cm in group 2 (p >0.05). The mean index of elastic lengthening was 0.21 (range 0.06 to 0.34) in group 1 vs 0.64 (range 0.38 to 0.88) in group 2 (p <0.001). The difference in the mean length of the urethral gap between children and adults in the 2 groups was not statistically significant (2.4 vs 2.5 cm, p >0.05), while the difference in the mean length of the bulbar urethra was highly significant (5.6 vs 7.7 cm, p <0.001). Bulboprostatic urethral gaps shorter than a third of bulbar urethral length are usually corrected by a simple perineal operation. For longer gaps an elaborated perineal or transpubic procedure is usually done. Also, the latter 2 procedures are more commonly performed in children than in adults because of the shorter bulbar urethra.

Mechanism of Continence After Repair of Posterior Urethral Disruption: Evidence of Rhabdosphincter Activity

Controversy exists regarding continence mechanisms in patients who undergo posterior urethral reconstruction after pelvic fracture. Some evidence suggests that continence after posterior urethroplasty is maintained by the bladder neck or proximal urethral mechanism without a functioning distal mechanism. We studied distal urethral sphincter activity in patients who have undergone posterior urethroplasty for pelvic fracture. A total of 12 patients who had undergone surgical repair of urethral disruption involving the prostatomembranous region underwent videourodynamics with urethral pressure profiles at rest, and during stress and hold maneuvers. Bladder pressure and urethral pressure, including proximal and distal urethral sphincter activity and pressure, were assessed in each patient. All 12 patients had daytime continence of urine postoperatively with a followup after anastomotic urethroplasty of 12 to 242 months (mean 76). Average maximum urethral pressure was 71 cm H2O. Average maximum urethral closure pressure was 61 cm H2O. The average urethral pressure seen during a brief hold maneuver was 111 cm H2O. Average functional sphincteric length was 2.5 cm. Six of the 12 patients had clear evidence of distal urethral sphincter function, as demonstrated by the profile. Continence after anastomotic urethroplasty for posttraumatic urethral strictures is maintained primarily by the proximal bladder neck. However, there is a significant contribution of the rhabdosphincter in many patients.

Internal urethrotomy combined with antegrade flexible cystoscopy for management of obliterative urethral stricture.

We studied the safety and efficacy of flexible cystoscopy-guided internal urethrotomy in the management of obliterative urethral strictures. Forty-three flexible cystoscopy-guided internal urethrotomies were performed between 1999 and 2005. The indication for the procedure was nearly blinded bulbar or membranous urethral strictures not longer than 1 cm that would not allow passage of guide wire. Candidates were those who refused or were unable to undergo urtheroplasty. By monitoring any impression of the urethrotome on the monitor through the flexible cystoscope, we were able to do under-vision urethrotomy. All of the patients were started clean intermittent catheterization afterwards which was tapered over the following 6 months. Follow-up continued for 24 months after the last internal urethrotomy. Seventeen patients were younger than 65 years with a history of failed posterior urethroplasty, and 26 were older than 65 with poor cardiopulmonary conditions who had bulbar urethral stricture following straddle or iatrogenic injuries. Urethral stricture stabilized in 16 patients (37.2%) with a single session of urethrotomy and in 17 (39.5%) with 2 urethrotomies. Overall, urethral stricture stabilized in 76.7% of patients with 1 or 2 internal urethrotomies within 24 months of follow-up. No severe complication was reported. Flexible cystoscopy-guided internal urethrotomy is a simple, safe, and under-vision procedure in obliterative urethral strictures shorter than 1 cm. It can be an ideal option for patients who do not accept posterior urethroplasty or are in a poor cardiopulmonary condition that precludes general anesthesia.

Urethral Reconstruction for Traumatic Posterior Urethral Disruption: Outcomes of a 25-Year Experience

Management of posterior urethral disruption due to pelvic trauma can be quite challenging and is the subject of ongoing controversy. This study presents an update of the University of California, San Francisco experience with delayed anastomotic posterior urethroplasty for management of these injuries. Since 1979 all patients undergoing posterior urethroplasty by a single surgeon at University of California, San Francisco and its affiliated hospitals have been entered prospectively into a patient registry. For this cohort descriptive statistics were calculated and recurrence was analyzed with the Kaplan-Meier method. Success was defined as no recurrence (by symptoms and/or retrograde urethrogram) or a mild recurrence managed successfully with a single internal urethrotomy. A total of 134 male patients were analyzed with a mean of 32.9 and a median of 12 months followup. Mean patient age at surgery was 34.8 years. Of the patients 35% had undergone at least 1 prior procedure for stricture including prior urethroplasty in 16%. In addition, 22% required partial pubectomy and 4% a combined abdominal-perineal approach with total pubectomy. Of patients with a closed bladder neck on urethrography 34% vs 7% of those with an open bladder neck required pubectomy (p <0.001). Stricture length tended to be longer in pubectomy cases (mean 3.2 vs 2.1 cm by urethrography, p = 0.055). Of the patients 14% experienced recurrent stricture at a mean of 12 months, 42% of whom were treated successfully with a single urethrotomy. The overall success rate allowing 1 direct vision internal urethrotomy was 93%. Anastomotic urethroplasty offers excellent long-term results to patients with posterior urethral trauma and stricture disease even after multiple prior procedures.

Simplified Reconstruction of Posterior Urethral Disruption Defects: Limited Role of Supracrural Rerouting

We present our combined experience with a simplified posterior urethroplasty technique to determine the necessity and usefulness of ancillary reconstructive maneuvers. We reviewed the records of 135 men and 7 boys who underwent reconstruction of traumatic posterior urethral defects with greater than 1 year of followup from 5 tertiary teaching hospitals. Prior treatments, surgical approach and ancillary techniques required during reconstruction were compiled. Direct anastomosis following scar excision and urethral mobilization alone was performed in 95 of the 142 males (67%). Formal corporal splitting was performed in 24 patients (17%) and inferior pubectomy in was done in 14 (10%). Supracrural urethral rerouting was performed in only 4 patients (3%), of whom 3 (75%) experienced recurrent stenosis. Abdominoperineal reconstruction, which was reserved mainly for salvage and pediatric cases, was required to reconstruct complex defects in 5 of the 142 cases (4%) and it was successful in 4 (80%). Early urethral realignment was associated with successful subsequent reconstruction in all patients in whom this maneuver was achieved (17 of 17 or 100%). This maneuver tended to be straightforward. Overall successful posterior urethral reconstruction was achieved in 130 of 142 cases (92%). Eight failures were successfully salvaged by internal urethrotomy (3) or repeat urethroplasty (5). Ancillary maneuvers such as corporal splitting or inferior pubectomy are seldom required for successful posterior urethral reconstruction. Urethral rerouting appears to be inferior to the abdominoperineal approach as a salvage maneuver for complex cases. Primary realignment appears to promote more simplified and successful surgical repair.

Bulbourethral Composite Suspension for Treatment of Male-Acquired Urinary Incontinence

ObjectivesWe evaluated the efficacy of bulbourethral composite sling procedure in the treatment of male urinary incontinence after radical prostatectomy, transurethral resection of the prostate, or prostatic enucleation for benign prostatic hyperplasia, and posterior urethroplasty. MethodsBetween May 2000 and April 2005, a bulbourethral composite sling was performed in 26 patients with acquired urinary incontinence. Eight (30.8%) of these patients had severe urinary incontinence, and 18 (69.2%) had mild to moderate urinary incontinence. A polyester patch plus tension-free vaginal tape (TVT) device was used in the procedure. Prolene threads were attached to the two ends of polyester taper then passed from the perineal incision to a suprapubic incision with a TVT needle. The ends of the sutures and TVT were tied over the rectus fascia in the midline after repeated urethral pressure measurements reached 80–90cmH2O. ResultsThe follow-up period was 8–54 mo (mean: 28.3). The primary procedure failed in one patient. Of the remaining 25 patients, 1 patient died of cerebral hemorrhage 2 yr postoperatively, and 2 patients had recurrent stress incontinence in 1.5 and 2 yr postsurgery, respectively. The recurrent incontinence was severe in one patient and mild (one to two pads per day) in the other. The remaining 22 patients maintained urination and continence. The total success rate (cure and improved) was 92% (23 of 25). ConclusionsBulbourethral composite sling procedure is a minimally invasive, safe, effective surgical option in the treatment of male patients with mild to moderate incontinence, but is not suitable for severe incontinence. Temporary perineal discomfort or pain is a common complication of the procedure.

Early versus delayed internal urethrotomy for recurrent urethral stricture after urethroplasty in children.

Our aim was to evaluate the results of early versus delayed internal urethrotomy for management of recurrent urethral strictures after posterior urethroplasty in children. Twenty boys with proven posterior urethral strictures were treated by perineal posterior urethroplasty. Of these, 12 required internal urethrotomy. Each radiograph demonstrated a patent but irregular urethra with a decrease in diameter at the point of repair (fair results). Patients were then divided into 2 groups: 6 underwent early (within 6 weeks from urethroplasty), and 6 underwent delayed (after 12 weeks from urethroplasty), internal urethrotomy with the cold knife as a complementary treatment. The groups were comparable in terms of patient age, etiology of the primary urethral stricture, number of recurrences, length and site of the actual stricture, and preoperative maximum flow rate. Mean follow-up was 5 years. Kaplan-Meier analyses showed that the stricture-free rate was 66.6% after early, and 33.3% after delayed, internal urethrotomy (P = .03). Early internal urethrotomy should be considered in boys with recurrent urethral stricture after urethroplasty.