Management of obliterative posttraumatic posterior urethral strictures after failed initial urethroplasty.
OBJECTIVE
We evaluate the problems encountered during surgery and assess the results of different endoscopic and open surgical methods following failed urethroplasty for posttraumatic posterior urethral stricture.


METHODS
Since 1992 we have treated 23 patients in whom urethroplasty for posterior urethral strictures failed. Of these patients, 3 had undergone 2 previous repairs and 6 had additional complicating factors, such as fistula, periurethral cavity and false passage. End-to-end anastomosis was done in 14 patients via a transperineal (7) or transpubic (7) approach. In 1 patient substitution urethroplasty using a radial artery based forearm free flap was performed. In 3 patients a 2-stage urethroplasty was done, 4 underwent core-through optical internal urethrotomy and 1 underwent endoscopic marsupialization of a false passage.


RESULTS
At 1 to 5-year followup 3 of the 23 patients had restenoses (13%), including 2 in whom previous treatment failed. The remaining 87% of the patients void well and are continent, and there is no worsening of the preexisting potency status.


CONCLUSIONS
Previous failed urethral stricture repair complicates management due to fibrosis, impaired vascularity and limited urethra available for mobilization. Recurrent strictures less than 1.5 cm. can be managed successfully with core-through internal urethrotomy. End-to-end anastomosis is possible in the majority with generous use of inferior pubectomy or the transpubic approach with certain modifications. When residual inflammation or long strictures are present a 2-stage procedure is a safer option. Overall, reoperation can offer a successful outcome for the majority of these complex strictures.
Wadhwa
S N
SN
Department of Urology, All India Institute of Medical Sciences, New Delhi.
Chahal
R
R
Hemal
A K
AK
Gupta
N P
NP
Dogra
P N
PN
Seth
A
A
D000328:Adult; D000714:Anastomosis, Surgical; D004724:Endoscopy; D050723:Fractures, Bone / Q000150:complications; D006801:Humans; D010384:Pelvic Bones / Q000293:injuries; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology / Q000601:surgery*