Complex urethral disruptions: in pursuit of a successful reconstruction.
OBJECTIVE
We analyzed the methods and outcomes of urethroplasty in men with complex urethral disruptions.


METHODS
The medical records of 40 men with complex urethral disruptions were analyzed. Surgical methods were individualized according to stricture location, severity and length of the stricture, bladder neck characteristics and presence of complicating factors. Patients were divided into four groups based on the above characteristics.


RESULTS
End-to-end urethroplasty performed in six patients with short bulbar strictures (<3 cm) was successful in all. Elaborated perineal repair was performed in 10 patients with intermediate (3-6 cm) strictures with or without complicating factors. Elaborated perineal repair with urethral substitution was performed in nine patients with long segment stricture (>6 cm). Abdominal transpubic repair was successfully applied to patients with rectourethral fistula or lacerated bladder neck. Success rate of anastomotic urethroplasty was 95% while over all success rate was 85%.


CONCLUSIONS
Guidelines for urethral reconstruction of complex urethral disruptions are predicated on stricture length, location, bladder neck characteristics and associated complicating factors. End-to-end urethroplasty with stricture excision is highly reliable for short strictures for which previous operative repair have failed. Elaborated perineal repair is extremely versatile for intermediate and longer strictures with associated complicating factors. Abdominal transpubic urethroplasty is effective for patients with rectourethral fistula or lacerated bladder neck.
Pratap
Akshay
A
Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. akshaypratap2000@gmail.com
Gupta
Devendra Kumar
DK
Agrawal
Chandra Shekhar
CS
Pandit
Rakesh Kumar
RK
Adhikary
Shailesh
S
Kumar
Anand
A
Tiwari
Awadhesh
A
Singh
Satyendra Narayan
SN
D000328:Adult; D003558:Cystoscopy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014567:Urography; D013521:Urologic Surgical Procedures, Male / Q000379:methods*