The augmented anastomotic urethroplasty: Indications and outcome in 29 patients

Purpose: A short bulbar stricture of 1 cm, or less is best managed by stric ture excision and primary anastomosis, However, a dilemma exists when the t otal length of the stricture is too great for excision and anastomosis, Opt ions include stricture incision and flap-graft onlay or stricture excision with roof or floor strip anastomosis augmented by an onlay. We report our r esults with the latter type of augmented anastomotic urethroplasty. Materials and Methods: We retrospectively reviewed the. char ts of 29 patie nts who underwent augmented anastomotic urethroplasty between 1990 and 1999 . Retrograde urethrography was performed 3 weeks and 3 months postoperative ly, and later if the patient was symptomatic. When possible, followup clini c notes and x-rays from referring physicians were obtained and patients wer e contacted directly to assess the long-term outcome. Results: The stricture was in the bulbar. urethra in all cases. Six patient s had a completely obliterative stricture. Mean stricture length was 1.5 cm . on retrograde urethrography and the mean excised length was 1.2 cm. In 9 of the 29 patients a roof strip anastomosis was augmented by a ventral onla y and in 20 a floor strip anastomosis was formed with a dorsal onlay. Onlay s included a pedicled skin flap in 7 cases and a graft in 22. Mean onlay le ngth was 4.5 cm, At a mean followup of 28 months (range 3 to 126) 27 of the 29 patients (93%) were stricture-free and all those surveyed were satisfie d with the procedure. Complications include new erectile dysfunction in 1 p atient, post-void dribbling in 13, pseudodiverticulum formation in 2 and su bjective penile shortening in 5. Conclusions: Augmented anastomotic urethroplasty is a useful technique for strictures that are too long to be managed by excision and primary anastomo sis. Greater than 90% of the patients are stricture-free and the results se em durable, although longer followup is needed. Complications are few and m inor.