DOI: http://dx.doi.org/10.18203/2349-2902.isj20200821

An audit of management of male urethral stricture and it’s outcome: a single centre retrospective review

Puskal Kumar Bagchi, Sarbartha K. Pratihar, Rajeev T. P., Sasanka K. Barua, Debanga Sarma, Mandeep Phukan

Abstract


Background: Anterior urethral stricture involves penile, bulbar or panurethra with varied aetiology. Direct vision internal urethrotomy (DVIU), stricture excision with primary end to end anastomosis, single stage or staged reconstruction with local flap or buccal mucosal graft (BMG) are surgical options.

Methods: This single centre retrospective study was conducted from April 2017 to March 2019. Patient underwent DVIU, stricture excision with primary end to end anastomotic, staged urethroplasty, BMG urethroplasty (BMGU) dorsal inlay Asopa technique, dorsal onlay Kulkarni technique and ventral onlay technique depending on site and extent of strictures. Preoperative, intraoperative, post-operative data were reviewed.

Results: Here, 51 patients underwent DVIU for single soft short segment bulbar urethral stricture with success rate 58.82%. 26 patients with post traumatic short segment bulbar urethral stricture underwent excision and primary end to end anastomosis with success rate 92.31%. Patients with long segment bulbar urethral stricture underwent either dorsal onlay (n=19) or ventral onlay (n=14) BMGU with success rate 89.47% and 85.71% respectively. Total 59 patients with long segment penile or pan urethral stricture underwent either single stage (n=27) or staged reconstruction (n=32) with success rate of 85.18% and 90.63% respectively. Patients with staged reconstruction had significantly longer hospital stay (p<0.0001) and poor quality of life due to laid opened urethra. Asopa’s dorsal inlay (n=15) and Kulkarni’s dorsal onlay (n=12) BMGU had equivalent success rate of 86.67% and 83.33% and comparable complications.

Conclusions: Surgery for urethral stricture differs according to site and extent of stricture. Single stage BMG urethroplasty is preferred modality for long segment bulbar, penile and panurethral stricture. 


Keywords


Asopa’s dorsal onlay BMGU, DVIU, Kulkarni’s dorsal onlay BMGU, Stricture excision with primary end to end anatomosis, Urethroplasty, Ventral onlay

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References


Santucci RA, Joyce GF, Wise M. Male urethral stricture disease. J Urol. 2007;177(5):1667-74.

Pansadoro V, Emiliozzi P. Iatrogenic prostatic urethral strictures: classification and endoscopic treatment. Urology. 1999;53(4):784-9.

Maciejewski C, Rourke K. Imaging of urethral stricture disease. Trans Androl Urol. 2015;4(1):2.

Rourke KF, Jordan GH. Primary urethral reconstruction: the cost minimized approach to the bulbous urethral stricture. J Urol. 2005;173(4):1206-10.

Jezior JR, Schlossberg SM. Excision and primary anastomosis for anterior urethral stricture. Urolog Clin. 2002;29(2):373-80.

Pathak HR, Jain TP, Bhujbal SA, Meshram KR, Gadekar C, Parab S. Does site of buccal mucosa graft for bulbar urethra stricture affect outcome? A comparative analysis of ventral, dorso-lateral and dorsal buccal mucosa graft augmentation urethroplasty. Turkish J Urol. 2017;43(3):350.

Martins FE, Kulkarni SB, Joshi P, Warner J, Martins N. Management of long-segment and panurethral stricture disease. Advan Urol. 2015;2015.

Kulkarni S, Barbagli G, Sansalone S, Lazzeri M. One-sided anterior urethroplasty: a new dorsal onlay graft technique. BJU Int. 2009;104:1150-5.

Wessells H. Ventral onlay graft techniques for urethroplasty. Urolog Clin North Am. 2002;29(2):381-7.

Johanson B: Reconstruction of the male urethra in strictures. Acta Chir Scand. 1953;179:19.

Asopa HS, Garg M, Singhal GG, Singh L, Asopa J, Nischal A. Dorsal free graft urethroplasty for urethral stricture by ventral sagittal urethrotomy approach. Urology. 2001;58(5):657-9.

Gallegos MA, Santucci RA. Advances in urethral stricture management. F1000 Res. 2016;5:2913.

Bullock TL, Brandes SB. Adult anterior urethral strictures: a national practice patterns survey of board certified urologists in the United States. J Urol. 2007;177(2):685-90.

Santucci R, Eisenberg L. Urethrotomy has a much lower success rate than previously reported. J Urol. 2010;183(5):1859-62.

Palminteri E, Berdondini E, Verze P, De Nunzio C, Vitarelli A, Carmignani L. Contemporary urethral stricture characteristics in the developed world. Urology. 2013;81(1):191-7.

Jordan GH, McCammon KA. Surgery of the Penis and Urethra. Oxford: Elsevier Saunders; 2012: 956-1000.

Micheli E, Ranieri A, Peracchia G, Lembo A. End‐to‐end urethroplasty: long‐term results. BJU Intern. 2002;90(1):68-71.

Santucci RA, Mario LA, Aninch JW. Anastomotic urethroplasty for bulbar urethral stricture: analysis of 168 patients. J Urol. 2002;167(4):1715-9.

Andrich DE, Dunglison N, Greenwell TJ, Mundy AR. The long-term results of urethroplasty. J Urol. 2003;170(1):90-2.

Eltahawy EA, Schlossberg SM, McCammon KA, Jordan GH. 315: Long Term Follow Up for Excision and Primary Anastomosis in Anterior Urethral Strictures. J Urol. 2005;173(4S):87.

Morey AF, Watkin N, Shenfeld O, Eltahawy E, Giudice C. SIU/ICUD consultation on urethral strictures: anterior urethra–primary anastomosis. Urology. 2014;83(3):23-6.

Humby G, Higgins TT. A one‐stage operation for hypospadias. Bri J Surg. 1941 Jul;29(113):84-92.

Barbagli G, Palminteri E, Rizzo M. Dorsal onlay graft urethroplasty using penile skin or buccal mucosa in adult bulbourethral strictures. J Urol. 1998;160(4):1307-9.

Kellner DS, Fracchia JA, Armenakas NA. Ventral onlay buccal mucosal grafts for anterior urethral strictures: long-term followup. J Urol. 2004;171(2):726-9.

Barbagli G, Selli C, Di Cello V, Mottola A. A one‐stage dorsal free‐graft urethroplasty for bulbar urethral strictures. Bri J Urol. 1996;78(6):929-32.

Elliott SP, Metro MJ, McANINCH JW. Long-term followup of the ventrally placed buccal mucosa onlay graft in bulbar urethral reconstruction. J Urol. 2003;169(5):1754-7.

Selim M, Salem S, Elsherif E, Badawy A, Elshazely M, Gawish M. Outcome of staged buccal mucosal graft for repair of long segment anterior urethral stricture. BMC Urol. 2019;19(1):38.

Warner JN, Malkawi I, Dhradkeh M, Joshi PM, Kulkarni SB, Lazzeri M, et al. A multi-institutional evaluation of the management and outcomes of long-segment urethral strictures. Urology. 2015;85(6):1483-8.