EXCISION AND ANASTOMOTIC REPAIR FOR URETHRAL STRICTURE DISEASE - EXPERIENCE WITH 150 CASES

Purpose: To analyze the results of a series of end-to-end urethroplast ies performed in our service from 1968 to 1995 and of the factors cont ributing to failure. Material and Methods: 150 men (mean age 35.9 year s) with urethral stricture disease underwent excision of the stricture and end-to-end anastomosis; in 95 it was the first attempt at repair while in 55 it was a secondary attempt. Eighty-two patients (54.6%) ha d a trauma-related stricture; of them, 56 followed a pelvic ring fract ure with posterior urethra distraction defect, 24 (16%) had inflammato ry strictures, 26 (17.3%) iatrogenic, 9 (6%) congenital, and 9 (6%) of unknown etiology; 81 (54%) were located in the bulbous urethra, 9 (6% ) in the penoscrotal junction and 2 (1.3%) in the penile urethra. Nine ty-one (60.6%) of the strictures or obliterative defects measured betw een 1 and 3 cm, 42 (28%) less than 1 cm and only 16 (10.6%) more than 3 cm. A perineal approach was used in 138 of the cases, while combined abdominoperineal route was necessary in 12; of these, 5 were children . The follow-up has ranged from 6 to 168 months (mean 44.4). The resul ts were classified as good, fair (some re-stricturing, not needing tre atment) and poor (recurrence). Results: One hundred and twenty-six (84 %) good outcomes, 10 (6.6%) fair, 14 (9.3%) poor. The factors influenc ing success or failure were: (1) primary or secondary character of the operation; (2) etiology; (3) length, and (4) location. Postoperative early complications consisted of 2 wound infections and 2 hematomas; a s late complications, 1 chordee, 2 incontinence, 7 erectile dysfunctio n (in previously potent patients). The 14 patients considered as failu res were operated again, all successfully; in 4 of them, a repeat exci sion and end-to-end anastomosis was performed, elevating the final suc cess rate of the series to 93.3%. Conclusion: Excision and anastomotic repair represent the optimal mode of stricture repair for single lesi ons located from the penoscrotal junction to the membranous part of th e urethra.