Simplified reconstruction of posterior urethral disruption defects: limited role of supracrural rerouting.
OBJECTIVE
We present our combined experience with a simplified posterior urethroplasty technique to determine the necessity and usefulness of ancillary reconstructive maneuvers.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Kizer
William S
WS
Brooke Army Medical Center, Fort Sam Houston, Texas 78234, USA.
Armenakas
Noel A
NA
Brandes
Steven B
SB
Cavalcanti
Andre G
AG
Santucci
Richard A
RA
Morey
Allen F
AF
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D014521:Urethra / Q000293:injuries* / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods