The augmented anastomotic urethroplasty: indications and outcome in 29 patients. J Urol 2001 May;165(5):1496-501
Date
05/09/2001Pubmed ID
11342904Scopus ID
2-s2.0-0035043407 (requires institutional sign-in at Scopus site) 144 CitationsAbstract
PURPOSE: A short bulbar stricture of 1 cm. or less is best managed by stricture excision and primary anastomosis. However, a dilemma exists when the total length of the stricture is too great for excision and anastomosis. Options include stricture incision and flap-graft onlay or stricture excision with roof or floor strip anastomosis augmented by an onlay. We report our results with the latter type of augmented anastomotic urethroplasty.
MATERIALS AND METHODS: We retrospectively reviewed the charts of 29 patients who underwent augmented anastomotic urethroplasty between 1990 and 1999. Retrograde urethrography was performed 3 weeks and 3 months postoperatively, and later if the patient was symptomatic. When possible, followup clinic notes and x-rays from referring physicians were obtained and patients were contacted directly to assess the long-term outcome.
RESULTS: The stricture was in the bulbar urethra in all cases. Six patients had a completely obliterative stricture. Mean stricture length was 1.5 cm. on retrograde urethrography and the mean excised length was 1.2 cm. In 9 of the 29 patients a roof strip anastomosis was augmented by a ventral onlay and in 20 a floor strip anastomosis was formed with a dorsal onlay. Onlays included a pedicled skin flap in 7 cases and a graft in 22. Mean onlay length was 4.5 cm. At a mean followup of 28 months (range 3 to 126) 27 of the 29 patients (93%) were stricture-free and all those surveyed were satisfied with the procedure. Complications include new erectile dysfunction in 1 patient, post-void dribbling in 13, pseudodiverticulum formation in 2 and subjective penile shortening in 5.
CONCLUSIONS: Augmented anastomotic urethroplasty is a useful technique for strictures that are too long to be managed by excision and primary anastomosis. Greater than 90% of the patients are stricture-free and the results seem durable, although longer followup is needed. Complications are few and minor.
Author List
Guralnick ML, Webster GDAuthor
Michael Guralnick MD Professor in the Urologic Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Anastomosis, Surgical
Humans
Male
Middle Aged
Postoperative Complications
Radiography
Surgical Flaps
Urethra
Urethral Stricture
Urologic Surgical Procedures
