Lower partial pubicectomy for postoperative complicated posterior urethral stricture

Abstract

Objective: To report the experience of partial inferior pubicectomy in the treatment of complex posterior urethral stricture after trauma.

Methods: A total of 46 patients with post-traumatic posterior urethral stricture admitted to the Department of Urology of our Hospital from January 2013 to September 2021 were selected as the research objects and underwent urethroplasty (including nine patients who had failed previous perineal repair surgery and adopted partial inferior pubicectomy approach). Retrograde urethrograph (RUG) and urine flow measurement were performed at 1, 3, 12 and 18 months after operation, and follow-up was performed when necessary. The clinical data during treatment were statistically analyzed.

Results: All 46 patients underwent urethroplasty successfully, of which nine were treated with partial pubicectomy, accounting for 19.57% of the total. The causes of the disease were motor vehicle accident in 4 cases, falling collision injury in 2 cases, and rolling injury of military exercise tank in 3 cases. Among the 9 patients, 2 were children (22.22%), aged 8 and 12 years, and 7 were adults (77.78%), aged 19-44 (28.42 ± 1.56) years. Among the 9 patients, 6 had erectile dysfunction, accounting for 66.67%. The length of posterior urinary tract stenosis was (5.12 ± 0.57) cm. The operation time was (290.34 ± 12.35) min from anesthesia induction to skin closure. Five patients received 2 U blood transfusion during operation and three patients received 3 U blood transfusion after operation. The average hospital stay was 12-16 (14.24 ± 1.25) days, and the follow-up was 12-24 (18.24 ± 1.35) months. After surgery, one patient developed HIP abscess, which was successfully treated conservatively. One patient had dysuria 1 month after operation and was successfully treated by transurethral dilatation. One case had postoperative infection and recovered after intravenous administration of potent antibiotics. Cystourethrography was performed 3 months after operation, and there was no difference between patients with wide, long or short anastomotic stretch defects. All patients met the criteria for surgical success.

Conclusion: Partial inferior pubicectomy is a good surgical procedure for the repair of complicated posterior urethral stricture after operation. It is safe and reliable, can better display the prostatic apex and surgical field, shorten the length of reconstructed urethra, and has good postoperative effect. It has no direct or long-term effect on the stability of pelvis or bladder. However, further studies in a larger cohort of patients with complex posterior urethral strictures after repair are needed to demonstrate the specific indications for partial pubicectomy.

Keywords: Complex posterior urethral stricture; Inferior partial pubicectomy; Urethroplasty.

Fig. 1

Lithotomy position, impact test, and boundary of the excised pubic bone symphysis excision

Fig. 2

Subpubic partial resection, exposure of posterior urethral stricture, resection of urethral stricture, and anastomosis of the new urethra to the posterior urethra

Fig. 3

Surgical Steps. Liberation of bulbar urethra (a, b); Lower body incision (c); Urethroplasty with diaphragm flap (d–f); Anastomosis of new urethra and prostate urethra (g); The greater omentum fills infrapubic space (h, i); Place the bracket (j); The patient urinates after operation (k)