Urethroplasty for posterior urethral strictures

OBJECTIVE: To assess the long-term results and complications of urethroplasty for patients with pelvic fracture injuries of the posterior urethra and to determine which type of of procedure is most appropriate. PATIENTS AND METHODS: Eighty-two patients were followed prospectively after undergoing transperineal bulboprostatic anastomotic urethroplasty (AU). The results and complications in these patients were compared with 59 patients who had a 'patch' urethroplasty (PU) for a short stricture which in other circumstances might have been amenable to AU. RESULTS: The 1-, 5- and 10-year re-stricture rates were 7, 12 and 12%, respectively, for AU and 12, 20 and 31% for PU. Four of the 10 patients who re-strictured during the 5-year follow-up after AU were > 55 years of age and four of the seven patients who had an AU and who were > 55 years old re-strictured. All the patients who re-strictured were impotent. The commonest complications after AU were principally a consequence of the original injury rather than the surgery, whereas the complications after PU were principally related to the surgery. Impotence sometimes occurred after both types of urethroplasty. CONCLUSIONS: Anastomotic urethroplasty is the best available procedure for traumatic proximal urethral strictures but was not tolerated well in the elderly and caused impotence in a small but significant proportion. The results of PU were less satisfactory and the difference became progressively more marked with a longer follow-up.