Urethroplasty for posttraumatic posterior urethral stricture: An outcome analysis.

To assess the outcome of urethroplasty for posttraumatic posterior urethral stricture. Materials and Methods : All male patients with posttraumatic posterior urethral stricture who underwent urethroplasty procedures in the urological unit at Siriraj hospital from January 1995-June 1998 were included in the study. The details of initial management by the primary hospitals, prior surgical manipulations carried out elsewhere, techniques of urethroplasty, results and complications, especially incontinence and impotence, were collected and analysed. Results : A total of 27 patients were included in the analysis. The follow-up period ranged from 2 to 34 months (mean 12.8 + 9 months). All patients had initial management for acute urethral disruptions from primary hospitals as follows : 21 patients (77.8%) had suprapubic cystostomy alone and 6 patients (22.2%) had suprapubic cystostomy plus urethral realignment. Fifteen patients (55.6%) had failed urethral surgery for stricture corrections when referred. Three techniques of urethroplasty; perineal urethroplasty; perineal urethroplasty with inferior pubectomy and combined abdomino-perineal transpubic urethroplasty were done in 16 (59%), 8 (30%) and 3 (11%) respectively. The success was not associated with either previous surgery or no previous surgery status. Incontinence occurred in 10 patients (37%), but in seven of these was mild. Impotence existed preoperatively in 19 cases (64%). Three of eight cases (37.5%) who were potent preoperatively developed impotence postoperatively. The potency outcome was not statistically between the suprapubic cystostomy alone group and suprapubic cystostomy plus urethral realignment group. Conclusion : The outcome of urethroplasty for posttraumatic posterior urethral stricture was acceptable. Although the incontinence rate was high, most of them were mild. Postoperative impotence rate was high and should be discussed with patients prior to surgery.