ABSTRACT
The aim of this work is to determine step wise procedures that would overcome long segment posterior defects and/or high prostatic apex in cases of post traumatic urethral defects. A total of 60 male patients presented with PUDD, a suprapubic tube was placed, and they were planned for delayed repair after 3 months. End to end anastomosis was contemplated after excision of all the scar tissue. In case the length of the defect, and the higher migration of the prostatic apex did not allow this tension free suturing the following maneuvers were undertaken: freeing the distal urethral segment till the penoscrotal junction, then development of the intercrural space, and if not sufficient, we utilized inferior pubectomy. After a mean follow up of 18 months [6-36], 60 patients were evaluated. Mean age was 43 years [27-68]. Twenty patients [group I] underwent end to end anastomosis [defect was <4cm]; 40 patients [group II] underwent end to end anastomosis with inferior pubectomy [defect > 4cm, or high riding prostate]. In group I, 14 out of 20 [70%] had a patent anastomosis and stricture recurred in 6 patients. In group II, 30 out of 40 [75%] had a patent anastomosis during follow-up. Of those 16 patients with recurrent stricture, 10 required visualized urethrotomy, and a redo anastomosis was done in 6 patients. Twelve [20%] developed new onset erectile dysfunction. Four patients had preoperative bladder neck insult, and suffered stress incontinence postoperatively. Four patients developed self limited local wound haematomas, one of them was infected and required drainage. AT could be cannluded that Shortening the distance between the distracted urethral ends can be achieved by inferior pubectomy that allows tension free anastomosis as well as smooth curved urethral pass from distal to proximal urethral ends. This procedure is preferred rather than using tissue transfer or difficult transpubic approach. Inferior pubectomy is indicated in case of long segment stricture posterior urethral defect and /or high prostate migration that will interfere with smooth pass of the urethra and results in urethral angulations