Revisiting One-Stage Urethroplasties for Distal Urethral Strictures

Abstract

Background: Reconstructive approaches for distal urethral strictures range from simple meatotomy to utilizing grafts or flaps depending on the etiology, length and location. We describe a contemporary cohort of distal urethral strictures and report a surgical technique termed distal one-stage urethroplasty developed to address the majority of distal urethral strictures encountered.

Methods: Thirty-four patients were included. The mean age was 56.7 years (range 15.7-84.9 years), the mean stricture length was 1.1 cm (0.5-1.5) and the mean follow-up was 42.5 months (28-61.3).

Results: The vast majority of distal strictures (27/34 (79.4%)) were treated with our hybrid one-stage approach combining a distal urethral reconstruction with excision of the scar tissue without the need to use grafts or flaps. The average stricture length was 0.68 cm and average operative time was 24.43 min. Post-operative spraying was reported in a minority of patients (4/27 (14.8%)). The length of stricture and surgery were significantly longer in those 7/34 (20.6%) patients in whom grafts or flaps were used (2.88 cm and 154.8 min, respectively, p < 0.001 for both when compared to the hybrid one-stage approach). We noted 6/34 (17.6%) recurrences of distal urethral strictures, all of which were treated successfully with graft and flap repairs.

Conclusions: The vast majority of distal urethral strictures are amenable to a distal one-stage urethroplasty, avoiding the use of grafts and/or flaps while achieving reasonable outcomes. This limited approach, at least initially, is associated with shorter operative time and time of catheter placement and avoids morbidity associated with graft or flap harvesting. Spraying of urine is seldomly encountered and comparable to other approaches addressing distal urethral strictures.

Keywords: meatotomy; urethral reconstruction; urethral stricture; urethroplasty.

Figure 1

Distal one-stage urethroplasty. (A) Patients present with a distal stricture involving the distal fossa navicularis and meatus. The majority of patients have a history of urethral instrumentation. (B) The scar is located predominantly ventrally, as demonstrated. (C) The scar tissue is resected making an incision just underneath the urethral mucosa on glans epithelium. Removal of the scar creates a wedge-shape defect, as illustrated. (D) The urethral mucosa is then everted towards the glans epithelium using 5-0 PDS II sutures. (E) The result is a reconstructed meatus that is more slit-like than in a meatotomy. (F) A close up illustration of the reconstructed distal urethra.