Analysis of factors contributing to success or failure of 1-stage urethroplasty for urethral stricture disease

• Published in: The Journal of urology Vol. 151; no. 4; p. 869
• Main Authors: Roehrborn, C G, McConnell, J D
• Format: Journal Article
• Language: English
• Published: United States 01.04.1994
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Follow-Up Studies; Humans; Male; Middle Aged; Surgical Procedures, Operative - methods; Sutures; Treatment Outcome; Urethra - surgery; Urethral Stricture - complications; Urethral Stricture - etiology; Urethral Stricture - pathology; Urethral Stricture - surgery; Urinary Tract Infections - complications
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1016/S0022-5347(17)35109-1

We reviewed charts with adequate documentation and followup (mean 24.6 months) between 1970 and 1987 of 110 patients who had undergone 1-stage urethroplasty for urethral stricture disease at our institutions. Two age peaks were observed, 1 in the younger population (21 to 30 years old) with traumatic strictures (50% of all strictures) and 1 in elderly men (61 to 70 years old) with mainly post-inflammatory strictures (28.2% of all strictures). The majority of all strictures (63.6%) were in the bulbous urethra. Only strictures induced by trauma were located in the membranous urethra (total 28.2%). A patch graft repair was used in 49.1% of all cases, an end-to-end technique in 29.1% and a transpubic repair in 21.8%. Overall, a 57% rate of excellent results was observed with 24% failures. The results were best for patch graft repairs (65% excellent), followed by end-to-end repairs (56% excellent) and transpubic repairs (42% excellent). The choice of the surgical approach in urethral stricture surgery is dictated by the location of the stricture. The location in turn is dependent on the etiology of the stricture. Consequently, the cause of the stricture affects the location and character of the stricture and, therefore, has an immediate impact on the choice of the surgical approach and, thus, the outcome of the patient. The failure rate doubled overall when the patients had a previous manipulation for the stricture disease or if the urine was infected preoperatively despite antibiotic coverage. While our patient population may not be representative for other institutions, some general conclusions regarding proper management and treatment selection can be drawn from our experience.