An Audit of Urethroplasty Techniques used for Managing Anterior Urethral Strictures at a Tertiary Care Teaching Institute-What We Learned
Dr. Abhishek J Savalia,
219, Department of Urology, College Building, Lokmanya Tilak Municipal General Hospital,
Sion, Mumbai-400022, Maharashtra, India.
Introduction: Anastomotic and augmented urethroplasty for managing bulbar urethral strictures and Johansonâ€™s staged urethroplasty for managing penile, penobulbar and panurethral strictures are established techniques. In the field of urethroplasty, a reconstructive surgeon refines and evolves his technique at regular intervals, through an audit of his results.
Aim: To review our results and techniques on urethroplasty conducted at a tertiary care teaching institute, and to refine them where found lacking.
Materials and Methods: A retrospective review of records was done (2012 to 2016). A total of 90 patients underwent urethroplasty for anterior urethral strictures, of which 76 were available for follow up. Twenty nine men underwent End-To-End Urethroplasty (EEU); 14 underwent augmented urethroplasty for bulbar strictures; 33 underwent staged urethroplasty for penile/penobulbar/panurethral strictures. They were followed for mean 21 months (range 1-48 months) with the help of Retrograde Urethrogram (RGU), Micturating Cystogram (MCU) and Uroflowmetry (UFR) at three and six months and one year. Cystoscopy was reserved for those who had recurrent symptoms or RGU/UFR was suspicious of recurrent stricture. Success was defined as absence of obstructive symptoms and no recurrence in RGU, UFR or cystoscopy.
Results: Most common causes were trauma and idiopathic. Average stricture length was 1.8, 3 and 4.5 cm for EEU, augmented and staged urethroplasty respectively. Primary success rate was 86%, 85% and 57% for EEU, staged urethroplasty and augmented urethroplasty respectively. Secondary success rate for augmented urethroplasty after single Visual Internal Urethrotomy (VIU) was 86%.
Conclusion: Our results with EEU and staged urethroplasty are comparable with international studies; however, augmented urethroplasty had lower primary success rate. Introducing augmented anastomotic urethroplasty instead of just augmentation for dense spongiofibrosis and extending dorsal spatulation into healthy urethra may improve our success rates.