UroToday- A short bulbar urethral stricture with minimal spongiofibrosis can be treated with minimally invasive means such as direct vision incisional urethrotomy (DVIU) with an anticipated success rate of 60% at 48 months. In less than these ideal conditions the success rate is much lower. The alternative is definitive management with formal urethroplasty. A review of a large series of short bulbar urethral strictures treated with excision and primary anastomosis (EPA) was recently reported by Gerald Jordan and colleagues from Eastern Virginia Medical School in Norfolk, Virginia. The paper is published in the May 2007 issue of the Journal of Urology.

The charts of 260 patients over a 20-year period who underwent EPA were reviewed. During the same time an additional 1,195 patients underwent other anterior urethral reconstructions. Pelvic fracture distraction defects were excluded as the authors feel this to be a different and unique group. The mean stricture length was 1.9 cm (range 0.5 to 4.5 cm). Mean patient age was 38.4 years and 94 patients (36%) had a history trauma involving the bulbar urethra, most commonly a straddle injury while 25 (10%) had a history of urethral instrumentation or catherization as the insulting etiology. In 127 patients (48.8%) no cause for stricture could be identified. Mean follow-up was 50.2 months and included urethroscopy at 6 months.

Analysis of the results revealed that 257 patients (98.8%) were symptom free and required no further procedures. Recurrent strictures occurred early in 2 patients and late in 1. Two patients opted for intermittent dilations and a single DVIU was performed in one patient 4 years post-operatively. Complications encountered were position related neuropraxia in 9 (3.4%), early UTI in 13 (5%), chest related in 5 (1.9%), scrotalgia in 4 (1.5%), and wound related in 4 (1.5%). All resolved in the early post-operative period. Erectile dysfunction was seen in 6 (2.3%) patients of whom 4 had a history of significant straddle trauma and 4 responded well to oral pharmacotherapy.

In conclusion, excision with primary anastomosis for anterior urethral strictures has a very high success rate (98.8%) with durable long-term results in most patients. Complications are few and of short duration and self-limited. When possible, the authors believe that this procedure is clearly the best choice for short anterior urethral strictures.

Eltahawy EA, Virasoro R, Schlossberg SM, McCammon KA, Jordan GH

J Urol. 2177(5):1803-6, May 2007

Reported by UroToday Contributing Editor Michael J. Metro, M.D.

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