Urethroplasty for posterior urethral strictures

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Abstract
To assess the long-term results and complications of urethroplasty for patients with pelvic fracture injuries of the posterior urethra and to determine which type of of procedure is most appropriate. Eighty-two patients were followed prospectively after undergoing transperineal bulboprostatic anastomotic urethroplasty (AU). The results and complications in these patients were compared with 59 patients who had a 'patch' urethroplasty (PU) for a short stricture which in other circumstances might have been amenable to AU. The 1-, 5- and 10-year re-stricture rates were 7, 12 and 12%, respectively, for AU and 12, 20 and 31% for PU. Four of the 10 patients who re-strictured during the 5-year follow-up after AU were > 55 years of age and four of the seven patients who had an AU and who were > 55 years old re-strictured. All the patients who re-strictured were impotent. The commonest complications after AU were principally a consequence of the original injury rather than the surgery, whereas the complications after PU were principally related to the surgery. Impotence sometimes occurred after both types of urethroplasty. Anastomotic urethroplasty is the best available procedure for traumatic proximal urethral strictures but was not tolerated well in the elderly and caused impotence in a small but significant proportion. The results of PU were less satisfactory and the difference became progressively more marked with a longer follow-up.

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