The augmented anastomotic urethroplasty: indications and outcome in 29 patients

Abstract

Purpose: A short bulbar stricture of 1 cm. or less is best managed by stricture excision and primary anastomosis. However, a dilemma exists when the total length of the stricture is too great for excision and anastomosis. Options include stricture incision and flap-graft onlay or stricture excision with roof or floor strip anastomosis augmented by an onlay. We report our results with the latter type of augmented anastomotic urethroplasty.

Materials and methods: We retrospectively reviewed the charts of 29 patients who underwent augmented anastomotic urethroplasty between 1990 and 1999. Retrograde urethrography was performed 3 weeks and 3 months postoperatively, and later if the patient was symptomatic. When possible, followup clinic notes and x-rays from referring physicians were obtained and patients were contacted directly to assess the long-term outcome.

Results: The stricture was in the bulbar urethra in all cases. Six patients had a completely obliterative stricture. Mean stricture length was 1.5 cm. on retrograde urethrography and the mean excised length was 1.2 cm. In 9 of the 29 patients a roof strip anastomosis was augmented by a ventral onlay and in 20 a floor strip anastomosis was formed with a dorsal onlay. Onlays included a pedicled skin flap in 7 cases and a graft in 22. Mean onlay length was 4.5 cm. At a mean followup of 28 months (range 3 to 126) 27 of the 29 patients (93%) were stricture-free and all those surveyed were satisfied with the procedure. Complications include new erectile dysfunction in 1 patient, post-void dribbling in 13, pseudodiverticulum formation in 2 and subjective penile shortening in 5.

Conclusions: Augmented anastomotic urethroplasty is a useful technique for strictures that are too long to be managed by excision and primary anastomosis. Greater than 90% of the patients are stricture-free and the results seem durable, although longer followup is needed. Complications are few and minor.