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Delayed Anastomotic Posterior Urethroplasty : Longterm Results

Author: Hayder M. AL-Aridy
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 2 Pages: 248-256
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:There is still controversy regarding the treatment of post-traumatic posterior urethral distraction injuries. Initial suprapubic cystostomy and delayed perineal urethral reconstruction has been considered the reference standard.OBJECTIVE:We review our experience with delayed perineal urethral reconstruction,with a focus on the long-term outcome and complications. PATIENTS AND METHODS:Between March 2007 and April 2012, 56 patients with posterior urethral distraction injury due to pelvic trauma underwent reconstruction with delayed perineal approach. Motor car accident were the main mode of trauma ocuring in 34 patients(60.71%)followed by blunt pelvic trauma in 15 patients(26.78%)and fall from height in 5 patients(8.92%).Bullet injury in 2 patients(3.57%).The definitive repair was delayed after a time interval ranging from 2 to 9 months (mean 2.83±1.14) after initial management . Mean patient age was 30.16±15.31 (range 6 to 65) years. In all cases, the area of fibrosis was aggressively excised, the corpus spongiosum was mobilized, and a tension-free, spatulated end-to-end anastomosis was achieved by splitting the corporeal bodies. The preoperative evaluation consisted of combined antegrade and retrograde cystourethrograms . A detailed sexual history was obtained in all patients . RESULTS:After a mean follow-up of 29.78±15.79 months (range 9 to 60 months ), 50 patients(89.28%) had a successful outcome (with or without additional urethrotomy).6 patients (10.71%)was considered a surgical failure ,endoscopy was unsuccessful .The patients is scheduled for another trial of surgical repair.CONCLUSION:Our results support the belief that delayed perineal reconstruction with extensive excision of fibrosis and a tension-free, spatulated end-to-end anastomosis is a successful treatment for posterior urethral distraction defects, with acceptable morbidity.KEY WORDS:urethral stricture,posterior urethral injuries,urethroplasty.

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