Two-stage urethroplasties and perineal urethrostomy.
OBJECTIVE
Complex stenoses of the bulbar urethra and long stenoses of the penile urethra are very difficult to solve. Which surgical techniques must be applied in these  cases is not clear. The objectives of this work were to define whether two-stage urethroplasties and definitive perineal urethrostomies are currently valid techniques for these cases  and to clarify to what extent patients accept perineal urethrostomy.


METHODS
167 cases of urethral stenosis are reviewed: 73 of them correspond to long penile, both bulbar and penile, multiple or panurethral stenosis. The surgical procedures carried out in these 73 cases, essentially definitive perineal urethrostomy or two-stage surgery with a cutaneous graft implant, are analyzed. The results are evaluated as positive or negative according to the quality of voiding measured by the degree of satisfaction and urethrocystogram.


RESULTS
Far from being obsolete, these techniques are shown on the one hand to be ideal nowadays, with good results between 96.1% in penile urethra stenosis and  71.4%  in panurethral stenosis, and, on the other to be an opportunity for a definitive perineal derivation chosen voluntarily by 55% of patients who were programmed for a  second stage. The most frequently-occurring complications in this type of surgery, like graft necrosis and retraction of the perineal meatus, are confirmed. We recognize the number of cases studied is limited to make representative statistical conclusions, but the work is justified by their infrequency and the need to contribute  with our experience.


CONCLUSIONS
Two-stage urethral stenosis surgery and definitive perineal urethrostomy are highly acceptable techniques in certain complex cases. In two-stage urethral stenosis the grafts at the level of penile urethra produce better results and are easier to implant than bulbar-penile urethra grafts.  Patients accept definitive perineal urethrostomies well.
Urology Department, Leon University Hospital, Spain. fgallo@saludcastillayleon.es
F J Gallo
FJ
Rolanía
S Monagas
SM
Arteaga
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010413:Penis / Q000601:surgery; D010502:Perineum; D016038:Skin Transplantation; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*