Operative techniques of anastomotic posterior urethroplasty for traumatic posterior urethral strictures.
OBJECTIVE
To elucidate the details of operative technique of anastomotic posterior urethroplasty for traumatic posterior urethral strictures in attempt to offer a successful result.


METHODS
We reviewed the clinical data of 106 patients who had undergone anastomotic repair for posterior urethral strictures following traumatic pelvic fracture between 1979 and 2004. Patients'age ranged from 8 to 53 years (mean 27 years). Surgical repair was performed via perinea in 72 patients, modified transperineal repair in 5 and perineoabdominal repair in 29. Follow-up ranged from 1 to 23 years (mean 8 years).


RESULTS
Among the 77 patients treated by perineal approaches, 69 (95.8%) were successfully repaired and 27 out of the 29 patients (93.1%) who were repaired by perineoabdominal protocols were successful. The successful results have sustained as long as 23 years in some cases. Urinary incontinence did not happen in any patients while impotence occurred as a result of the anastomotic surgery.


CONCLUSIONS
Three important skills or principles will ensure a successful outcome, namely complete excision of scar tissues, a completely normal mucosa ready for anastomosis at both ends of the urethra, and a tension-free anastomosis. When the urethral stricture is below 2.5 cm long, restoration of urethral continuity can be accomplished by a perineal procedure. If the stricture is over 2.5 cm long, a modified perineal or transpubic perineoabdominal procedure should be used. In the presence of a competent bladder neck, anastomotic surgery does not result in urinary incontinence. Impotence is usually related to the original trauma and rarely (5.7%) to urethroplasty.
Zhou
Zhan-song
ZS
Urologic Research Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, China. zhouzhansong@sohu.com
Song
Bo
B
Jin
Xi-yu
XY
Xiong
En-qing
EQ
Zhang
Jia-hua
JH
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014521:Urethra / Q000601:surgery; D014525:Urethral Stricture / Q000209:etiology / Q000601:surgery*; D013520:Urologic Surgical Procedures