ABSTRACT
Background: Anterior urethral stricture involves penile, bulbar or panurethra with varied aetiology. Direct vision internal urethrotomy (DVIU), stricture excision with primary end to end anastomosis, single stage or staged reconstruction with local flap or buccal mucosal graft (BMG) are surgical options.Methods: This single centre retrospective study was conducted from April 2017 to March 2019. Patient underwent DVIU, stricture excision with primary end to end anastomotic, staged urethroplasty, BMG urethroplasty (BMGU) dorsal inlay Asopa technique, dorsal onlay Kulkarni technique and ventral onlay technique depending on site and extent of strictures. Preoperative, intraoperative, post-operative data were reviewed.Results: Here, 51 patients underwent DVIU for single soft short segment bulbar urethral stricture with success rate 58.82%. 26 patients with post traumatic short segment bulbar urethral stricture underwent excision and primary end to end anastomosis with success rate 92.31%. Patients with long segment bulbar urethral stricture underwent either dorsal onlay (n=19) or ventral onlay (n=14) BMGU with success rate 89.47% and 85.71% respectively. Total 59 patients with long segment penile or pan urethral stricture underwent either single stage (n=27) or staged reconstruction (n=32) with success rate of 85.18% and 90.63% respectively. Patients with staged reconstruction had significantly longer hospital stay (p<0.0001) and poor quality of life due to laid opened urethra. Asopa’s dorsal inlay (n=15) and Kulkarni’s dorsal onlay (n=12) BMGU had equivalent success rate of 86.67% and 83.33% and comparable complications.Conclusions: Surgery for urethral stricture differs according to site and extent of stricture. Single stage BMG urethroplasty is preferred modality for long segment bulbar, penile and panurethral stricture.
ABSTRACT
Introduction:DVIU is a common urological procedure forshort segment urethral stricture ≤2cm and is generally doneunder spinal anesthesia. The study was performed to accessthe feasibility to perform DVIU under local anesthesia toreduce the cost, hospital stay and the morbidity of anaesthesia.Material and Methods: A prospective randomized study wasconducted in 168 patients who were divided in two groups.Group ‘a’ received only ICS block intra corporospongiosalblock) and group ‘b’ received both ICS with USblock(urethrosphincteric block).VAS pain score was obtainedat the end and one hour after the procedure.Results: The visual analogue score (VAS) at the time ofprocedure were significantly lower for Group ‘b’ (Groupa =3.46, Group b=2.55 p value=0.0053), and was alsolower at the end of one hour (Group a=3.1, Group b=2.01 pvalue=0.0001). The change in blood pressure and pulse rateas a measure of hemodynamic variability were recorded inboth groups and significant differences were noted at the timeof procedure Group ‘a’ 6.43±1.08, Group ‘b’ 3.95±1.46, p <0.0001 value.Conclusion: DVIU is a common urological procedure whichcan be safely performed under local anaesthetic blocks insteadof spinal anaesthesia. A combination of ICS with US blockincreases the safety and tolerability of the procedure.