Urethral stricture following cardiovascular surgery: role of urethral ischemia.
The incidence of urethral stricture has been surprisingly high following cardiovascular surgery in the last few years. We conducted a prospective study on 68 male patients undergoing cardiovascular surgery to determine the main factor(s) responsible for the development of urethral stricture. The penile-brachial pressure index was checked by strain gauge plethysmography. We found that urethral strictures developed in 15 patients (22 per cent) within an average of 3 months after cardiovascular surgery. Of these patients 13 had a penile-brachial index of 0.6 or less and complained of erectile impotence. A latex type of catheter was used in 11 and a silicone catheter in 4 of these 15 patients for urinary drainage. We conclude that urethral ischemia has an important role in the development of stricture, particularly when a latex urethral catheter is used for drainage. We recommend that a vascular penile study should be done in patients with erectile impotence undergoing an open heart operation, and that serious consideration should be given to the use of a cystocatheter diversion the night before the operation in those with a penile-brachial index less than 0.6. We strongly recommend the use of a silicone catheter in all other patients undergoing open heart surgery with hypothermia.
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D006348:Cardiac Surgical Procedures; D007172:Erectile Dysfunction / Q000503:physiopathology; D005385:Fingers / Q000503:physiopathology; D006801:Humans; D007511:Ischemia / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010410:Penile Erection; D010413:Penis / Q000503:physiopathology; D010991:Plethysmography / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011446:Prospective Studies; D014521:Urethra / Q000098:blood supply*; D014525:Urethral Stricture / Q000209:etiology* / Q000503:physiopathology; D014546:Urinary Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods