Article

Repeat Transurethral Manipulation of Bulbar Urethral Strictures is Associated With Increased Stricture Complexity and Prolonged Disease Duration

Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
The Journal of urology (Impact Factor: 3.75). 03/2012; 187(5):1691-5. DOI: 10.1016/j.juro.2011.12.074
Source: PubMed

ABSTRACT We examined the association of previous transurethral manipulation with stricture complexity and disease duration among men referred for bulbar urethral reconstruction.
We retrospectively reviewed the records of 340 consecutive urethroplasties performed by a single surgeon between July 2007 and October 2010. Only men treated with initial open surgery for bulbar strictures were included in analysis, thus excluding those with hypospadias, lichen sclerosus, pelvic radiation, prior urethroplasty, incomplete data, or pure penile or posterior urethral stenosis. Cases were divided into 2 groups based on the history of transurethral treatment for urethral stricture before urethroplasty, including group 1-0 or 1 and group 2-2 or greater treatments.
Of 101 patients with bulbar urethral stricture and all data available 50 and 51 underwent 0 to 1 and 2 or greater previous transurethral treatments, respectively. Repeat transurethral manipulation was strongly associated with longer strictures and the need for complex reconstruction. Repeat transurethral manipulation of bulbar urethral strictures was also associated with an eightfold increase in disease duration between stricture diagnosis and curative urethroplasty.
Repeat transurethral manipulation of bulbar strictures is associated with increased stricture complexity and a marked delay to curative urethroplasty.

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    • "Also, PER followed by repeated instrumentation seemed to complicate the performance of posterior urethroplasty, an already challenging procedure. As might be expected, repeated dilatations can propagate scar formation [10], and in our experience, PER actually increased periurethral fibrosis (Fig. 1). Unfortunately, we also noted a wide range of adverse sequelae in these patients, e.g., synchronous stricture formation, false passages, initial urethroplasty failure, and/or infectious complications. "
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