End to end urethroplasty in bulbar stricture: Long term results

Background: urethral stricture (us) is a lifelong disease with high morbidity. bulbar urethra is most common site for the stricture. trauma,stds,repeated uti,instrumentation and rarely the malignancy are the causes of us. the hallmark of us is weak stream. antegrade/retrograde urethrogram are done for diagnosis and treatment. most commonly used treatment options are urethral dilatation,iou,laser urethrotomies and self intermittent dilatation. aim: to assess the long term outcome of end to end bulbar urethroplasty. methods: 150 patients were included in our study treated between jan-2011 to dec-2015. preoperative urethrogram was done routinely. patients who were treated previously by end to end urethroplasty were not included in the study. operation was performed under ga with patient in extended lithotomy position. the urethra was dissected,the fibrosed narrow part excised and ends were spatulated and four detached sutures with 4/0 vicryl at 3,6,9 and 12'oclock position were applied over 16fr foleys catheter. the catheter was retained for four weeks. cathether was removed when there was no extravasation on pericatheter urethrogram. if extravasation is present then catheter is retained for two more weeks. wound closed in layers. the patients were followed at 3rd,6th and 12th months post operatively. results: mean age was 29.8 (range 18 to 70). mean stricture length was 15mm (range 5 to 30 mm). mean operation time was 95 minutes (range 90 to 175 minutes). the stay was 5+/- 3 days. 83 patients (55.3%) had stricture due to trauma including iatrogenic,67 patients (44.6%) had stricture due to other causes. 117 patients (78%) were symptoms free at last follow up. 25 patients (16.6%) needed iou at first or second follow up and were considered as cured. 7 patients (4.6%) needed augmentation urethroplasty. 7 patients (4.6%) required one pint of blood transfusion. 9 patients (6%) had minor wound infection treated by sitz bath and antibiotic according to culture and sensitivity. out of 150 patients,143(95.3%) were symptoms free at last follow up and were considered as cured. out of 25 patients who required one or two sessions of iou post operatively,17 patients (68%) were those whose stricture was non traumatic in origin. conclusion: end to end urethroplasty is treatment of choice in short bulbar stricture with cure rate near to 95%.