By one-stage transperineal end-to-end anastomotic urethroplasty mostly all post-traumatic posterior urethral strictures in adults, can be corrected. In adults, transperineal anastomotic urethroplasty is the treatment of choice initially for posterior urethral strictures and secondly to direct or indirect pelvic trauma, which are usually situated at the membranous urethra. Approximations of urethra by transversal approach or delayed end-to-end urethroplasty were mainly options exercised in our setup. Result of Immediate approximation in dense fibrosis, loss of erectile function and occasionally incontinence. Due to this, the goal of the present study was to assess the outcome of delayed end-to-end anastomotic urethroplasty in post-traumatic stricture of posterior urethra.
PROCEDURE:
-
Surgery was done under general or spinal anaesthesia. After anaesthesia, patient were placed in exaggerated lithotomy position.
-
Midline cut in the perineum was made. Incision was deeply engrave to cut subcutaneous fat and bulbocavernous muscle in the centerline to expose the bulbar urethra.
-
A metallic bougie is passes through urethra till the stricture to assist the dissection. A window was created between the urethra and deeper structure, and urethra was dissected away from the corpora cavernosa distally upto penoscrotal junction so as to roughly the strictured segment.
-
Proximally cut was carried upto the stricture and after that more proximally approaching the actual part of urethra.
-
Proximal urethra was approached with bougie from suprapubic cystostomy port, going into urinary bladder neck and palpated perineally.
-
With the help of suprapubic and urethral bougie stricture length was estimated. The affected urethral segment was extirpated, followed by end-to-end anastomosis in which normal ends were spatulated and four interrupted sutures of 4/0 polyglycolic acid (vicryl 4/0) were applied over 18 Fr Foley’s catheter.
-
Hemostasis was protected and fascia and skin were closed in layers and bandage was applied.
-
All surgical procedures were performed by the same urologist without significant changes in standard technique. Intravenous antibiotic prophylaxis by cephradine and gentamicin were injected for 48 – 72 hours postoperatively and after that oral antibiotics were administered.
-
The patients were discharged on the 5th postoperative day, on average. These catheters are removed after 2 – 4 weeks and antegrade voiding cystourethrography (VCUG) or retrograde urethrography was performed out.
