Ramírez-Pérez EA, López-Silvestre JC, Pérez-Elizalde J, Elías-Zonana F

Language: Spanish
References: 10
Page: 63-71
PDF size: 537.55 Kb.

ABSTRACT

Introduction: Long or complex strictures (›2 cm) cannot be managed with excision and anastomosis because they can condition shortening of the penis or spermatic cord, or anastomotic failure. For this type of stricture, numerous techniques have been suggested, including total excision of the strictured segment with free graft or flap application, anastomosis with dorsal or ventral enlargement, and multiple-stage procedures.
Material and methods: Sixty-six urethroplasties were carried out in our hospital from October 2008 to June 2011 (a total of 20 months). Only seventeen patients with complex anterior urethral strictures (strictures encompassing the penile and bulbar urethra that varied from 4 to 15 cm with a mean length of 7 cm) underwent this technique, using a perineal approach with a 4 cm incision. Surgery duration, complications, and short-term and mid-term results were evaluated.
Results: Of the seventeen patients included in the study, thirteen had successful surgical outcomes (76%) and four presented with failure (24%). The main complications were dysesthesia in the perineal region (three patients, 17%) hematoma (one patient, 5%), and infection (one patient, 5%). Complications associated with taking the buccal mucosa graft were: a certain difficulty in opening the mouth (one patient, 5%), local pain at the site where the graft was taken that lasted more than three weeks (two patients, 11%), and dysesthesia in the mouth (one patient, 5%). Mean surgery duration was 180 minutes and there were no position-related complications.
Conclusions: We believe this technique is a good one-stage management option for complex anterior urethral stricture with mild to moderate spongiofibrosis. It offers very satisfactory functional and cosmetic results and has a low complication rate.

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