Simplified Reconstruction of Posterior Urethral Disruption Defects: Limited Role of Supracrural Rerouting

William S. Kizer, Noel A. Armenakas, Steven B. Brandes, Andre G. Cavalcanti, Richard A. Santucci, Allen F. Morey

Research output: Contribution to journalArticle

61 Scopus citations

Abstract

Purpose: We present our combined experience with a simplified posterior urethroplasty technique to determine the necessity and usefulness of ancillary reconstructive maneuvers. Materials and Methods: We reviewed the records of 135 men and 7 boys who underwent reconstruction of traumatic posterior urethral defects with greater than 1 year of followup from 5 tertiary teaching hospitals. Prior treatments, surgical approach and ancillary techniques required during reconstruction were compiled. Results: Direct anastomosis following scar excision and urethral mobilization alone was performed in 95 of the 142 males (67%). Formal corporal splitting was performed in 24 patients (17%) and inferior pubectomy in was done in 14 (10%). Supracrural urethral rerouting was performed in only 4 patients (3%), of whom 3 (75%) experienced recurrent stenosis. Abdominoperineal reconstruction, which was reserved mainly for salvage and pediatric cases, was required to reconstruct complex defects in 5 of the 142 cases (4%) and it was successful in 4 (80%). Early urethral realignment was associated with successful subsequent reconstruction in all patients in whom this maneuver was achieved (17 of 17 or 100%). This maneuver tended to be straightforward. Overall successful posterior urethral reconstruction was achieved in 130 of 142 cases (92%). Eight failures were successfully salvaged by internal urethrotomy (3) or repeat urethroplasty (5). Conclusions: Ancillary maneuvers such as corporal splitting or inferior pubectomy are seldom required for successful posterior urethral reconstruction. Urethral rerouting appears to be inferior to the abdominoperineal approach as a salvage maneuver for complex cases. Primary realignment appears to promote more simplified and successful surgical repair.

Original languageEnglish (US)
Pages (from-to)1378-1382
Number of pages5
JournalJournal of Urology
Volume177
Issue number4
DOIs
StatePublished - Apr 1 2007

Keywords

  • fractures, bone
  • pelvis
  • urethra
  • urethral stricture
  • wounds and injuries

ASJC Scopus subject areas

  • Urology

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