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 yea rs. Stricture was corrected by optical urethrotomy in 12 cases, urethr oscrotal inlay in 23, perineal anastomotic urethroplasty in 78 and tra nspubic urethroplasty in 32. Results were almost always successful aft er anastomotic urethroplasty, whether performed by the perineal (95%) or transpubic (97%) route. Therefore, this procedure deserves to be re garded as the gold standard for the treatment of posttraumatic posteri or urethral strictures and disruptions. Urethral anastomosis should be attempted first through the perineum in every case, with the transpub ic procedure done only when a tension-free bulbo-prostatic anastomosis could not be accomplished from below the stricture. Optical urethroto my was successful (58%) in patients with mild strictures and a persist ent opening between the bulbar and prostatic areas of the intact ureth ra. Therefore, this procedure should be reserved for such cases. Repea ted 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 unde rmine the chance for subsequent anastomotic urethroplasty. A urethrosc rotal inlay procedure is doomed to failure in 57% of the cases and (wi th other substitution procedures) it should be restricted to stricture s involving extensive segments of the posterior and/or anterior urethr a. Sexual impotence usually (15%) resulted from the original pelvic fr acture urethral injury and rarely (2.5%) from the urethroplasty itself .