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J Urol. 2007 Apr;177(4):1374-7.

Anastomotic urethroplasty for posttraumatic urethral stricture: previous urethral manipulation has a negative impact on the final outcome.

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1
Department of Urology, Bichat Hospital, Paris, France.

Abstract

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.

PMID:
17382735
DOI:
10.1016/j.juro.2006.11.092
[Indexed for MEDLINE]
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