One-stage urethroplasty for strictures at a rural hospital

Abstract

Introduction: St Mary’s Mission Hospital manages many inflammatory and traumatic urethral strictures. Previously, we treated strictures with dilatation, but high recurrence and poor patient satisfaction necessitated adoption of reconstructive procedures since 2017.

Objective: To review the scope, outcome and complications of urethroplasties using data collected prospectively.

Methods: All cases of one-stage urethroplasty were included. Patient biodata and pre-operative adverse factors were collected and analyzed.

Results: 23 male patients ranging in age from 24 to 74 years were studied: 9 strictures were inflammatory (40%), 9 were traumatic (40%), 3 (20%) were recurrent. Nineteen strictures were in the bulbar urethra (83%), 2 were cases of penile strictures and 1 case each of pan-urethral stricture and pelvic floor urethral distraction defect. Of the 23 procedures, 13 were simple anastomosis (57%), 5 were dorsal buccal mucosa graft (BMG) urethroplasty (22%), 2 were cases of non-transecting anastomotic urethroplasty, and 1 case each of ventral BMG urethroplasty and Johansson’s and Kulkarni’s panurethroplasty. The overall complication rate was 40% (9 patients). Four patients (17%) had recurrence; 2 had fistula and 1 case each of persistent UTI, erectile dysfunction and periurethral abscess. Three of the four recurrences had undergone BMG urethroplasty. All cases of simple anastomosis had no recurrence.

Conclusion: Our centre has embraced diverse urethroplasties for a wide scope of patients. This study found a significant complication rate for substitution urethroplasties, suggesting a need for careful patient selection and an improvement in technique.

Keywords: Stricture, Urethroplasty, One-stage, Complications, Outcome