THE LESSONS OF 145 POSTTRAUMATIC POSTERIOR URETHRAL STRICTURES TREATED IN 17 YEARS

We reviewed our experience with 145 posterior urethral strictures and disruptions complicating pelvic fracture urethral injury during 17 years. Stricture was corrected by optical urethrotomy in 12 cases, urethroscrotal inlay in 23, perineal anastomotic urethroplasty in 78 and transpubic urethroplasty in 32. Results were almost always successful after anastomotic urethroplasty, whether performed by the perineal (95%) or transpubic (97%) route. Therefore, this procedure deserves to be regarded as the gold standard for the treatment of posttraumatic posterior urethral strictures and disruptions. Urethral anastomosis should be attempted first through the perineum in every case, with the transpubic procedure done only when a tension-free bulbo-prostatic anastomosis could not be accomplished from below the stricture. Optical urethrotomy was successful (58%) in patients with mild strictures and a persistent opening between the bulbar and prostatic areas of the intact urethra. Therefore, this procedure should be reserved for such cases. Repeated urethrotomy of a long fibrous segment between a widely distracted prostatic and bulbar urethra would not only have a poor result but, by jeopardizing the elasticity of the anterior urethra, it also may undermine the chance for subsequent anastomotic urethroplasty. A urethroscrotal inlay procedure is doomed to failure in 57% of the cases and (with other substitution procedures) it should be restricted to strictures involving extensive segments of the posterior and/or anterior urethra. Sexual impotence usually (15%) resulted from the original pelvic fracture urethral injury and rarely (2.5%) from the urethroplasty itself.