Comparative long term results of first line surgical therapies for bulbar and posterior urethral strictures

ABSTRACT

We present our long term comparative results in the management of buldar and posterior urethral strictures using various first line surgical techniques. From January 1983 to January 2000 and with a mean follow-up of 58 months and a median of 34 months, 120 males with bulbar and posterior urethral strictures were managed in our tertiary care hospital. Only first line; therapies, selected by the respective treating urologist, were included in order to assess their efficacy and cost benefit value. Results of endoscopic management of bulbar strictures were correlated to ecology, the length of the stricture and previous urethrotomies. Optical urethrotomy was successful in 40% of the patients. However, when the stricture was short less than 2cm with no history of previous urethrotomy, the relapse rate was only 33%. Holmium laser urethrotomy was successful 60% of selected cases. Perineal and transpubic urethroplasties were highly successful in the management of bulbo-membranous and membranous strictures, with a success rate of 85% and 88% respectively, There was no difference in surgical results according to the etiology of the stricture. Optical and internal urethrotomy and Holmium - YAG laser urethrotomy are highly successful as first line therapies for short [less than 2cm] bulbar urethral stictures with no previous urethrotomies. They may also be indicated in older people with one failed internal urethrotomy. Perineal and transpubic urethroplasties are the gold standards for the management of bulbar, bulbo-membranous and membranous strictures. Treatment should be tailored to each individual case for optimal results: