Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2003 / Cilt: 29 - Sayı: 1
Anastomotic posterior perineal urethroplasty on patients with posterior urethral stricture: Our experiences on 21 cases
- Pages
- 58–62
- DOI
- —
Abstract
Introduction: Posterior urethral distraction injuries are usually secondary to pelvic trauma. Rarely, infections or iatrogenic traumas can also cause posterior urethral strictures. But, the main treatment strategies of these strictures are similar in any etiologies. The primary goal of treatment of posterior urethral injuries should be achieving urinary continence while minimizing stricture formation as well as sexual impotence. During the past 25 years, the mainstay of therapy has been suprapubic cystostomy, followed by delayed urethral reconstruction up to 3 to 4 months later. In this study, we evaluated delayed anastomotic posterior perineal urethroplasty on cases with posterior urethral strictures of various etiologies. Patients and methods: Between 1996 and 2001, anastomotic posterior perineal urethroplasty was performed on 21 male patients 20 to 81 years of age. While 17 of them had no previous surgery, 4 cases had at least one unsuccessful surgery. The etiology of the stricture was urethral disruption injury on 19 patients, infection on 1 patient and iatrogenic on 1 patient. All cases with traffic accident injury had pelvic fracture. All cases were evaluated by combined retrograd and antegrad urethrography, preoperatively. A detailed sexual function history was obtained in all cases. The follow-up consisted of periodic visits every 3 months during the first postoperative year and annually thereafter. Findings: Follow-up period ranged from 3 to 70 months (mean 21±9 months) and stricture length ranged from 1 to 4 cm (mean 2.3±0.8 cm). Inferior pubectomy was performed on only a case with a stricture of 4 cm long on whom urethral mobilization and corporeal separation were performed. Stricture was occurred at anastomotic site in 2 patients at 3r month postoperatively. Our success rate was 90%. Mean Qmax was 27.6±8.4 ml/s (8 to 35 ml/s) and mean Qave was 14.7±4.3 ml/s (6 to 19 ml/s) in postoperative 3 rd month. Stress urinary incontinence occurred in only 1 patient and was treated with only Kegel exercise. Only one patient had erectile dysfunction on the postoperative evaluation. Erectile dysfunction was improved spontaneously in this patient at the end of postoperative 6 th month. Results: Anastomotic posterior urethroplasty has acceptable morbidity and successful postoperative results on management of posterior urethral strictures. Aggressive fibrotic tissue excision, tension-free and mucosa to mucosa anastomosis are the most important factors of successful surgery.
Özet
Bu çalışmada çeşitli etyolojiler ile oluşan posteriyor üretra darlıklı olgularda, geç dönemde uygulanan anastomotik posteriyor perineal üretroplasti operasyonlarının irdelenmesi amaçlanmıştır. 1996-2002 yılları arasında, yaşları 20-81 arasında olan 21 erkek hastaya anastomotik posteriyor perineal üretroplasti uygulandı. Olgulardan 19'unda darlık nedeni üretral kopma yaralanması iken; l olguda enfeksiyon; diğer olgu da ise iyatrojenikti. Olgular operasyon öncesinde eş zamanlı retrograd ve antegrad üretrografıler ile darlığın yapısı açısından değerlendirildiler. Tüm olgulardan operasyon öncesi ayrıntılı cinsel fonksiyon öyküsü alındı. Takip süresi 3-70 ay arasında değişiyordu (Ortalama 21 ±9 ay). Darlık uzunlukları 1-4 cm arasında değişiyordu (Ortalama 2.3±0.8 cm). Yalnızca l olguya (darlık uzunluğu 4 cm olan) üretral mobilizasyon ve korporal separasyona ek olarak interiyor pubektomi uygulandı. 2 olguda operasyon sonrası 3. ayda anastomoz düzeyinde darlık gelişti. Başarı oranı %90 olarak bulundu. Postoperatif dönemde l olguda stres tarzında inkontinans saptandı. Operasyon sonrası yapılan değerlendirmede l olguda erektil disfonksiyon saptandı. Anastomotik posteriyor perineal üretra onarımı, posteriyor üretra darlıklarının tedavisinde, kabul edilebilir morbidite ve başarılı operasyon sonrası sonuçlara sahip bir operasyondur.