2005, Number 1
Rev Mex Urol 2005; 65 (1)
Experience in the management of complex posterior urethral strictures, through a posterior sagittal approach
Landa JS, Meneses JH
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ABSTRACTObjective. To evaluate the usefulness of the posterior sagittal approach for the one stage management of complex posterior urethral stricture. Materials and methods. Between January of 1990 to March of 2002, 29 patients with posterior urethral strictures underwent urethroplasty through a sagittal posterior approach. The outcome was good if the patient keeped the fecal or urinary continence and had normal erections, regular if the patient had mild incontinence or required urethral dilatations and bad if the patient had recurrent stricture that needs one more surgery or severe incontinence or erectil dysfunction. Results. Twenty nine patients underwent urethroplasty through a posterior sagittal approach. twenty five of them were men and four were women, 20 (68%) patients underwent end to end anastomosis, and 5 (17%) underwent substitution urethroplasty. In the 80% the outcome was good maintaining the continence and the erectil function, while the 20% the outcome was regular. One patient had mild urinary incontinence (3.5%) and two had mild impotence (6.8%). Conclusions. Extensives urethral stricture after traumatic injuries may be difficult to repair. The posterior sagittal approach provides exposure of the whole proximal urethra to facilitate repair even when there are large urethral defects that require graft interposition, without hampering fecal or urinary continence and preserving the sexual function.