FAILED ANTERIOR URETHROPLASTY - GUIDELINES FOR RECONSTRUCTION

Purpose: We analyzed the methods and outcomes of repeat urethroplasty in men with recurrent stricture after the failure of previous anterior urethroplasty. Materials and Methods: In 31 men with recurrent strict ure after previous urethroplasty anterior urethral reconstruction was performed. Reconstructive methods varied according to stricture length and location. Results: End-to-end urethroplasty performed in 11 of 13 men with short (average 1.8 cm.) bulbar strictures was successful in all. Patch graft urethroplasty was successfully done in 4 men with int ermediate (average 4.4 cm.) strictures. Penile circular fasciocutaneou s flap urethroplasty performed in 13 of 14 men with long or distal str ictures (average 8 cm.) was successful in 10 (79%). Overall excellent results were obtained in 28 of the 31 cases (90%). Conclusions: Guidel ines for urethral reconstruction after failed anterior urethroplasty a re predicated on stricture length, location and severity. Circular fas ciocutaneous flap urethroplasty is extremely versatile and effective f or refractory long or distal strictures. End-to-end urethroplasty with stricture excision is highly reliable for less extensive bulbar stric tures for which previous operative repair has failed. Grafts are best used selectively in the reoperative setting.