Selection of operative approaches for the treatment of complicated urethral strictures / 中华泌尿外科杂志

ABSTRACT

Objective This study was to discuss various operative approaches for the repair complicated posterior urethral strictures. Methods 34 patients with posterior urethral strictures and associated ure-throrectal fistulas (URFs) were reviewed. The etiology of urethral strictures and fistula was due to pelvic fracture in 26 patients, iatrogenic in 6 cases and fall injury in the remaining 2 cases. The patients were treated by using a simple perineal approach (4 patients), a transperineal inferior pubectomy approach (21 patients) and combined abdominal transpubic perineal approach (9 patients) and URF repair and anastomotic urethroplasty were performed simultaneously in all cases. Results One-stage repair was successful in four patients (100%) using a simple perineal approach, in 19 of 21 (90. 48%) using the transperineal-inferior pubectomy approach and 7 of 9 (77. 78%) using the transpubic-perineal approach. Of the 34 patients, recurrent urethral strictures developed in two cases, recurrent URFs developd in two patients. Conclusions Surgical approaches for the special complex urethral strictures should be based on the location of the URF, its etiology and length of the urethral strictures, as well as a history of previous repairs. The transperineal-inferior pubic approach may be appropriate as a first-line procedure.