PURPOSE: We evaluated the long-term results of anastomotic urethroplasty for posttraumatic urethral stricture and assessed the impact of previous endourethral/surgical intervention on the subsequent outcome. MATERIALS AND METHODS: From January 1988 to April 2005, 51 patients underwent anastomotic urethroplasty for posttraumatic urethral stricture following pelvic fracture (41) or perineal blunt trauma (10). Of these patients 28 (55%) underwent previous surgical procedures, including endoscopic urethrotomy with endoscopic realignment in 20 and open urethroplasty in 8. Median followup was 4.6 years. Results were evaluated. Success was characterized by a maximum urine flow of more than 15 ml per second, sterile urine, and normal urethral imaging and/or endoscopy. A satisfactory result was considered to be 1 episode of recurrence diagnosed on routine imaging/endoscopy that was successfully managed by 1 or 2 direct vision internal urethrotomies. Failure was characterized by the necessity for repeat instrumental and/or open surgery. Results were analyzed using Kaplan-Meier curves and the log rank test. RESULTS: At 1, 5 and 10 years overall success rates were 63%, 55% and 43%, while satisfactory result rates were 84%, 80% and 76%, respectively. However, the 23 patients without urethral manipulation before anastomotic urethroplasty had a satisfactory result of more than 90% vs more than 60% in patients with previous surgical treatment. These results were maintained for 100 months (p <0.05). CONCLUSIONS: Endoscopic and/or open urethral manipulation before anastomotic urethroplasty for posttraumatic urethral stricture has a significant impact on the outcome of urethral reconstruction. Cases of posttraumatic urethral stricture should preferably be referred to a center of expertise.
PURPOSE: We evaluated the long-term results of anastomotic urethroplasty for posttraumatic urethral stricture and assessed the impact of previous endourethral/surgical intervention on the subsequent outcome. MATERIALS AND METHODS: From January 1988 to April 2005, 51 patients underwent anastomotic urethroplasty for posttraumatic urethral stricture following pelvic fracture (41) or perineal blunt trauma (10). Of these patients 28 (55%) underwent previous surgical procedures, including endoscopic urethrotomy with endoscopic realignment in 20 and open urethroplasty in 8. Median followup was 4.6 years. Results were evaluated. Success was characterized by a maximum urine flow of more than 15 ml per second, sterile urine, and normal urethral imaging and/or endoscopy. A satisfactory result was considered to be 1 episode of recurrence diagnosed on routine imaging/endoscopy that was successfully managed by 1 or 2 direct vision internal urethrotomies. Failure was characterized by the necessity for repeat instrumental and/or open surgery. Results were analyzed using Kaplan-Meier curves and the log rank test. RESULTS: At 1, 5 and 10 years overall success rates were 63%, 55% and 43%, while satisfactory result rates were 84%, 80% and 76%, respectively. However, the 23 patients without urethral manipulation before anastomotic urethroplasty had a satisfactory result of more than 90% vs more than 60% in patients with previous surgical treatment. These results were maintained for 100 months (p <0.05). CONCLUSIONS: Endoscopic and/or open urethral manipulation before anastomotic urethroplasty for posttraumatic urethral stricture has a significant impact on the outcome of urethral reconstruction. Cases of posttraumatic urethral stricture should preferably be referred to a center of expertise.
Authors: Niels V Johnsen; David F Penson; W Stuart Reynolds; Douglas F Milam; Roger R Dmochowski; Melissa R Kaufman Journal: World J Urol Date: 2017-02-22 Impact factor: 4.226
Authors: Niels Vass Johnsen; Rachel A Moses; Sean P Elliott; Alex J Vanni; Nima Baradaran; Garrick Greear; Thomas G Smith; Michael A Granieri; Nejd F Alsikafi; Bradley A Erickson; Jeremy B Myers; Benjamin N Breyer; Jill C Buckley; Lee C Zhao; Bryan B Voelzke Journal: World J Urol Date: 2019-05-29 Impact factor: 4.226