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A comparison of one‐stage procedures for post‐traumatic urethral stricture repair
Author(s) -
Berger Andreas P.,
Deibl Martina,
Bartsch Georg,
Steiner Hannes,
Varkarakis John,
Gozzi Christian
Publication year - 2005
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2005.05523.x
Subject(s) - medicine , urethroplasty , surgery , urethral stricture , anastomosis , buccal mucosa , urethra , hypospadias , dorsum , anatomy , dentistry , oral cavity
OBJECTIVE To compare the results and complication rates of various one‐stage treatments for repairing a post‐traumatic urethral stricture. PATIENTS AND METHODS The medical records of 153 patients who had a post‐traumatic urethral stricture repaired between 1977 and 2003 were evaluated retrospectively, and analysed for the different types of urethral reconstruction. RESULTS The procedures included direct end‐to‐end anastomosis in 86 (56%) patients, free dorsal onlay graft urethroplasty using preputial or inguinal skin in 40 (26%), ventral onlay urethroplasty using buccal mucosa in seven (5%) and ventral fasciocutaneous flaps on a vascular pedicle in 20 (13%). At a mean (median, range) follow‐up of 75.2 (38, 12–322) months, 121 (79%) patients had no evidence of recurrent stricture, while in 32 men (21%) they were detected at a mean follow‐up of 30.47 (1–96) months. Patients having a dorsal onlay urethroplasty had the longest strictures. The re‐stricture rate was lowest after a dorsal onlay urethroplasty (5% vs 27% when treated with end‐to‐end anastomosis, 15% after fasciocutaneous flaps and 57% after a ventral buccal mucosal graft). The surgical technique used had no effect on postoperative incontinence or erectile dysfunction rates. CONCLUSION In patients with strictures which are too long to be excised and re‐anastomosed, tension‐free dorsal onlay urethroplasty is better than ventral graft or flap techniques. In patients with short urethral strictures direct end‐to‐end anastomosis remains an option for the one‐stage repair of urethral stricture.