Post-traumatic posterior urethral strictures: preoperative decision making.

OBJECTIVES: To assess the reliability of certain preoperative findings in helping select the correct operation for post-traumatic posterior urethral strictures and distraction defects.
METHODS: We reviewed all urethrography and endoscopy studies of 167 posterior urethral strictures and distraction defects complicating pelvic fracture urethral injury that had been corrected between 1977 and 2002. Correction was by anastomotic urethroplasty in 149 cases (107 perineal, 2 elaborated perineal, 40 perineo-abdominal), scroto-urethral inlay in 2, and optical urethrotomy in 16. The findings were correlated with those encountered during surgery.
RESULTS: Successful results after optical urethrotomy were encountered only in cases of genuine urethral stricture with no loss of urethral continuity. Anastomotic urethroplasty could be accomplished by an ordinary perineal procedure when the length of the distraction defect was 3 cm or less and only by an elaborated perineal or a perineo-abdominal procedure when it was 3 cm or more. The 2 cases that were corrected by scrotal inlay had an extensively scarred anterior urethra that precluded urethral anastomosis.
CONCLUSIONS: A genuine stricture may indicate optical urethrotomy, but a distraction defect indicates anastomotic urethroplasty. Defects shorter than 3 cm may be corrected by an ordinary perineal anastomosis, while defects longer than 3 cm usually need an elaborated perineal or perineo-abdominal procedure. The finding of a scarred anterior urethra usually precludes urethral anastomosis and dictates substitution urethroplasty.