title: Complex urethral disruptions: in pursuit of a successful reconstruction.
abstract: 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.
authors: Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. akshaypratap2000@gmail.com
authors: Akshay
authors: A
authors: Pratap
authors: Devendra Kumar
authors: DK
authors: Gupta
authors: Chandra Shekhar
authors: CS
authors: Agrawal
authors: Rakesh Kumar
authors: RK
authors: Pandit
authors: Shailesh
authors: S
authors: Adhikary
authors: Anand
authors: A
authors: Kumar
authors: Awadhesh
authors: A
authors: Tiwari
authors: Satyendra Narayan
authors: SN
authors: Singh
mesh_terms: 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*