Complex urethral disruptions: In pursuit of a successful reconstruction

Authors

  • Akshay Pratap,

    Corresponding author
    1. Departments of Surgery,
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    • Authors contributions: AP and DKG conceived the protocol. AP was the chief surgeon. CSA and RKP assisted the operations, and follow up of the patients. SA and AK performed the published work search. AT conducted the radiological studies. SNS provided the anesthesia support.

  • Devendra Kumar Gupta,

    1. Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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    • Authors contributions: AP and DKG conceived the protocol. AP was the chief surgeon. CSA and RKP assisted the operations, and follow up of the patients. SA and AK performed the published work search. AT conducted the radiological studies. SNS provided the anesthesia support.

  • Chandra Shekhar Agrawal,

    1. Departments of Surgery,
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    • Authors contributions: AP and DKG conceived the protocol. AP was the chief surgeon. CSA and RKP assisted the operations, and follow up of the patients. SA and AK performed the published work search. AT conducted the radiological studies. SNS provided the anesthesia support.

  • Rakesh Kumar Pandit,

    1. Departments of Surgery,
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    • Authors contributions: AP and DKG conceived the protocol. AP was the chief surgeon. CSA and RKP assisted the operations, and follow up of the patients. SA and AK performed the published work search. AT conducted the radiological studies. SNS provided the anesthesia support.

  • Shailesh Adhikary,

    1. Departments of Surgery,
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    • Authors contributions: AP and DKG conceived the protocol. AP was the chief surgeon. CSA and RKP assisted the operations, and follow up of the patients. SA and AK performed the published work search. AT conducted the radiological studies. SNS provided the anesthesia support.

  • Anand Kumar,

    1. Departments of Surgery,
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    • Authors contributions: AP and DKG conceived the protocol. AP was the chief surgeon. CSA and RKP assisted the operations, and follow up of the patients. SA and AK performed the published work search. AT conducted the radiological studies. SNS provided the anesthesia support.

  • Awadhesh Tiwari,

    1. Radiology, and
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    • Authors contributions: AP and DKG conceived the protocol. AP was the chief surgeon. CSA and RKP assisted the operations, and follow up of the patients. SA and AK performed the published work search. AT conducted the radiological studies. SNS provided the anesthesia support.

  • Satyendra Narayan Singh

    1. Anesthesia, B.P. Koirala Institute of Health Sciences, Dharan, Nepal, and
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    • Authors contributions: AP and DKG conceived the protocol. AP was the chief surgeon. CSA and RKP assisted the operations, and follow up of the patients. SA and AK performed the published work search. AT conducted the radiological studies. SNS provided the anesthesia support.


Akshay Pratap mch, Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Email: akshaypratap2000@gmail.com

Abstract

Objectives:  We analyzed the methods and outcomes of urethroplasty in men with complex urethral disruptions.

Methods:  The medical records of 40 men with complex urethral disruptions were analyzed. Surgical methods were individualized according to stricture location, severity and length of the stricture, bladder neck characteristics and presence of complicating factors. Patients were divided into four groups based on the above characteristics.

Results:  End-to-end urethroplasty performed in six patients with short bulbar strictures (<3 cm) was successful in all. Elaborated perineal repair was performed in 10 patients with intermediate (3–6 cm) strictures with or without complicating factors. Elaborated perineal repair with urethral substitution was performed in nine patients with long segment stricture (>6 cm). Abdominal transpubic repair was successfully applied to patients with rectourethral fistula or lacerated bladder neck. Success rate of anastomotic urethroplasty was 95% while over all success rate was 85%.

Conclusion:  Guidelines for urethral reconstruction of complex urethral disruptions are predicated on stricture length, location, bladder neck characteristics and associated complicating factors. End-to-end urethroplasty with stricture excision is highly reliable for short strictures for which previous operative repair have failed. Elaborated perineal repair is extremely versatile for intermediate and longer strictures with associated complicating factors. Abdominal transpubic urethroplasty is effective for patients with rectourethral fistula or lacerated bladder neck.

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