Posttraumatic Posterior Urethral Stricture Repair: Anatomy, Surgical Approach and Long-Term Results

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Abstract
We describe the anatomy, surgical approach and long-term results of posterior urethral stricture repair. Between 1975 and 1991, 86 patients underwent surgery for posttraumatic posterior urethral stricture. In 65 patients the urethral lesion was corrected by 1-stage reconstructive surgery via the perineal approach. In 21 patients the urethra was reconstructed with a 2-stage procedure. In an anatomical study the course of the urethra through the pelvic floor was investigated and the concomitant structures were dissected. According to the anatomy a perineal approach was used in 7 male adult cadavers. Due to the optimized anastomotic technique urinary flow rates of more than 20 ml. per second could be achieved in 29 of all 42 patients followed. Only 6 of these patients had peak urinary flow rates of less than 15 ml. per second. No patient had any recurrent strictures at the anastomotic site that would have required surgical revision. Our results suggest that adequate primary care and the perineal approach combined with an exact anastomosis technique are essential for successful treatment of posttraumatic strictures of the posterior urethra.