Mechanism of continence after repair of post-traumatic posterior urethral strictures

Abstract

Objectives: To determine the mechanism of urinary continence after repair of post-traumatic posterior urethral strictures by perineal anastomotic urethroplasty.

Methods: Two groups of male patients were enrolled in this study. Group 1 consisted of 8 patients (mean age 31 years) who had undergone bulboprostatic anastomotic urethroplasty for strictures complicating a pelvic fracture urethral disruption. Group 2 consisted of 8 patients (mean age 32.5 years) with a normal urethra who were used as controls. All 16 patients underwent urethral pressure profilometry both at rest and with cough and hold maneuvers.

Results: In group I, urethral pressure profilometry showed much lower mean maximal urethral pressures and maximal urethral closure pressures, as well as a much shorter mean functional profile length than in group 2 (48 and 39 cm H(2)O versus 75 and 65 cm H(2)O and 2.4 versus 4 cm, respectively, P <0.0003). On cough maneuver, intra-abdominal pressure changes were transmitted along the entire functional profile length in group 1 and only along its first part in group 2. The hold maneuver increased urethral pressure in 5 patients (65%) in group 1 and in all 8 patients (100%) in group 2.

Conclusions: Continence after anastomotic urethroplasty for post-traumatic posterior urethral strictures is maintained solely by the proximal urethral mechanism. Transmission of intra-abdominal pressure changes and contraction of pelvic floor musculature may augment urethral closure in these cases during stress conditions.