Summary
Urethroplasty has excellent success rates against urethral stricture that far exceed that found with direct visual internal urethrotomy (DVIU) and dilation. Different forms of urethroplasty were employed including, buccal mucosal (BM), fasciocutaneous and anastomotic urethroplasty. Complications of urethroplasty are directly related to location of stricture, surgical technique, type of substitution tissue, and length of stricture. These complications range from mild and temporary to severe and complicated ones, which result in failure of urethroplasty. We present in this chapter an extensive review of the literature for complications of urethroplasty. Limitations in current published papers are the lack of a universally accepted definition of treatment failure and that reports are mixed complications for heterogeneous groups of strictures, treated by different modalities and surgeons.
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References
Al-Qudah HS, Santuci RA (2005) Extended complications of urethroplasty. Int Braz J Urol 31:315
Flynn BJ, Delvecchio FC, Webster GD (2002) Perineal repair of posterior urethral stricture and defect: Experience in 79 cases in the last 5-years. J Urol 167
Santucci RA, Mario LA, McAninch JW (2002) Anastomotic urethroplasty for bulbar urethral stricture: analysis of 168 patients. J Urol 167:1715
Elliott SP, Metro MJ, McAninch JW (2003) Long-term followup of the ventrally placed buccal mucosa onlay graft in bulbar urethral reconstruction. J Urol 169:1754
Pansadoro V, Emiliozzi P, Gaffi M, et al. (2003) Buccal mucosa urethroplasty in the treatment of bulbar urethral strictures. Urology 61:1008
Andrich DE, Leach CJ, Mundy AR (2001) The Barbagli procedure gives the best results for patch urethroplasty of the bulbar urethra. BJU Int 88:385
Heyns CF, Steenkamp JW, De Kock ML et al. (1998) Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful? J Urol 160:356
Pansadoro V, Emiliozzi P (1996) Internal urethrotomy in the management of anterior urethral strictures: long-term followup. J Urol 156:73
Greenwell TJ, Castle C, Andrich DE et al. (2004) Repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor cost-effective. J Urol 172:275
Heyns CF, S. J., De Kock ML,Whitaker P (1998) Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful? J Urol 160:356
Jakse G, Marberger, H (1986) Excisional repair of urethral stricture. Follow-up of 90 patients. Urology 27:233
Jezior JR, Schlossberg SM (2002) Excision and primary anastomosis for anterior urethral stricture. Urol Clin North Am 29:373–380
Martinez-Pineiro JA, Carcamo P, Garcia Matres MJ, et al. (1997) Excision and anastomotic repair for urethral stricture disease: experience with 150 cases. Eur Urol 32:433
Azoury BS, Freiha FS (1976) Excision of urethral stricture and end to end anastomosis. Urology 8:138
Schlossberg SM (2000) Anastomotic urethral reconstruction. Presented at the American Urologic Association postgraduate course, Atlanta, Georgia
Barbagli G, G. G, Palminteri E, Lazzeri M. (2006) Anastomotic fibrous ring as cause of stricture recurrence after bulbar onlay graft urethroplasty. J Urol 176:614
Wessells H, McAninch JW (1996) Use of free grafts in urethral stricture reconstruction. J Urol 155
Andrich DE, Mundy AR (2001) Substitution urethroplasty with buccal mucosal-free grafts. J Urol 165
Barbagli G, Selli C, Tosto A et al. (1996) Dorsal free graft urethroplasty. J Urol 155:123
Palminteri E, Lazzeri M, Guazzoni G, Turini D, Barbagli G (2002) New 2-stage buccal mucosal graft urethroplasty. J Urol 167:130
Dubey D, Kumar A., Mandhani A, Srivastava A, Kapoor R, Bhandari M (2005) Buccal mucosal urethroplasty: a versatile technique for all urethral segments. BJU Int. 95:625–629
Gupta NP, A. M., Dogra PN, Tandon S (2004) Dorsal buccal mucosal graft urethroplasty by a ventral sagittal urethrotomy and minimal-access perineal approach for anterior urethral stricture. BJU Int 93:1287
Fichtner J, Filipas D, Fisch M, et al. (2004) Long-term outcome of ventral buccal mucosa onlay graft urethro-plasty for urethral stricture repair. Urology 64:648
Zinman L (2003) The use of buccal mucosal graft onlay in urethral reconstruction. Am J Urol Rev 1:45
el-Kasaby AW, Fath-Alla M, Noweir AM, el-Halaby MR, Zakaria W, el-Beialy MH (1993) The use of buccal mucosa patch graft in the management of anterior urethral strictures. J Urol 149:276–278
Barbagli G, Palminteri E, Guazzoni G, et al. (2005) Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique? J Urol 174:955
Dubey D, S. A., Srivastava A, Mandhani A, Kapoor R, Kumar A (2005) Buccal mucosal urethroplasty for balanitis xerotica obliterans related urethral strictures: the outcome of 1 and 2-stage techniques. J Urol 173:463
Heinke T, Gerharz EW, Bonfig R, et al. (2003) Ventral onlay urethroplasty using buccal mucosa for complex stricture repair. Urology 61:1004
Elliott SP, Metro MJ, McAninch JW (2002) Long-term follow-up of the ventrally placed buccal mucosa onlay graft in bulbar urethral reconstruction. J Urol 167
Andrich DE, Dunglison N, Greenwell TJ, et al. (2003) The long-term results of urethroplasty. J Urol 170:90
Kane CJ, Tarman GJ, Summerton DJ, et al. (2002) Multi-institutional experience with buccal mucosa onlay urethroplasty for bulbar urethral reconstruction. J Urol 167:1314
Kellner DS, Fracchia JA, Armenakas NA (2004) Ventral onlay buccal mucosal grafts for anterior urethral strictures: long-term followup. J Urol 171:726
Barbagli G, P. E., Guazzoni G, Montorsi F, Turini D, Lazzeri M. (2005) Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique? J Urol 174:955
Bhargava S, C. C. (2004) Buccal mucosal ure-throplasty: is it the new gold standard? BJU Int 93:1191
Venn SN, Mundy AR (1998) Early experience with the use of buccal mucosa for substitution urethro-plasty. Br J Urol 81:738
Al-Qudah HS, C. A., Santucci RA. (2005) Early catheter removal after anterior anastomotic (3 days) and ventral buccal mucosal onlay (7 days) urethro-plasty. Int Brazil J Urol 31:459
Coursey JW, Morey AF, McAninch JW et al.(2001) Erectile function after anterior urethroplasty. J Urol 166:2273
Barbagli G, Selli C, di Cello V, et al. (1996) A one-stage dorsal free-graft urethroplasty for bulbar urethral strictures. Br J Urol 78:929
Yucel S, B. L (2003) Neuroanatomy of the male urethra and perineum. BJU Int 92:624
Andrich DE, Mundy AR (2000) Urethral strictures and their surgical treatment. BJU Int 86:571
Dubey D, Kumar A, Bansal P, Srivastava A, Kapoor R, Mandhani A, Bhandari M. (2003) Substitution urethroplasty for anterior urethral strictures: a critical appraisal of various techniques. BJU Int 91:215–218
Dublin N, Stewart LH (2004) Oral complications after buccal mucosal graft harvest for urethroplasty. BJU Int 94:867–869
Raber M, Naspro R, Scapaticci E, Salonia A, Scattoni V, Mazzoccoli B, Guazzoni G, Rigatti P, Montorsi F (2005) Dorsal onlay graft urethroplasty using penile skin or buccal mucosa for repair of bulbar urethral stricture: results of a prospective single center study. Eur Urol 48:1013–1017
Wood DN, Allen SE, Andrich DE, Greenwell TJ, Mundy AR. (2004) The morbidity of buccal mucosal graft harvest for urethroplasty and the effect of nonclosure of the graft harvest site on postoperative pain. J Urol 172:580–583
Morey AF, McAninch JW (1996) Technique of harvesting buccal mucosa for urethral reconstruction. J Urol 155:1696
Eppley BL, Keating M, Rink R. (1997) A buccal mucosal harvesting technique for urethral reconstruction. J Urol 157:1268–1270
Kamp S, Knoll T, Osman M, Hacker A, Michel MS, Alken P. (2005) Donor-site morbidity in buccal mucosa urethroplasty: lower lip or inner cheek? BJU Int 96:619–623
Tolstunov L, Pogrel MA, McAninch JW (1997) Intraoral morbidity following free buccal mucosal graft harvesting for urethroplasty. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84:480–482
Barbagli G (2004) When and how to use buccal mucosa grafts in penile and bulbar urethroplasty. Minerva Urol Nefrol 56:189
Meneghini A, Cacciola A, Cavarretta L, et al. (2001) Bulbar urethral stricture repair with buccal mucosa graft urethroplasty. Eur Urol 39:264
Pressman D, G. D. (1953) Reconstruction of the. perineal urethra with a free full thickness skin graft from the prepuce. J Urol 69:677
Jordan GH, Schlossberg SM (2002) Surgery of the penis and urethra, in Walsh P Retik AB, Vaughan ED, et al. (eds) Campbell's urology (ed 8). Philadelphia, Saunders, pp 3886–3954
Mundy AR (1995) The long-term results of skin inlay urethroplasty. Br J Urol 75:59
Koraitim M (2003) Failed posterior urethroplasty: lessons learned. Urology 62:719
Greenwell TJ, Venn SN, Mundy AR (1999) Changing practice in anterior urethroplasty. BJU Int 83:631
McAninch JW, Morey AF (1998) Penile circular fasciocutaneous skin flap in 1-stage reconstruction of complex anterior urethral strictures. J Urol 159:1209
Bhandari M, Dubey D, Verma BS (2001) Dorsal or ventral placement of the preputial/penile skin onlay flap for anterior urethral strictures: does it make a difference? BJU Int 88:39
Morey AF, Tran LK, Zinman LM (2000) Q-flap reconstruction of panurethral strictures. BJU Int 86:1039
Mundy AR (1993) Results and complications of urethroplasty and its future. Br J Urol 71:322
Baskin LS, Erol A, Li YW, Cunha GR (1998) Anatomical studies of hypospadias. J Urol 160: 1108–1115
Kessler TM, Fisch M, Heitz M, Olianas R, Schreiter F.(2002) Patient satisfaction with the outcome of surgery for urethral stricture. J Urol 167:2507–2511
Micheli E, Ranieri A, Peracchia G, Lembo A. (2002) End-to-end urethroplasty: long-term results. BJU Int 90:68–71
Roehrborn CG, McConnell JD (1994) Analysis of factors contributing to success or failure of 1-stage urethroplasty for urethral stricture disease. J Urol 151:869
Park S, McAninch JW (2004) Straddle injuries to the bulbar urethra: management and outcomes in 78 patients. J Urol 171:722
Barbagli G, Palminteri E, Bartoletti R, et al. (1997) Long-term results of anterior and posterior urethro-plasty with actuarial evaluation of the success rates. J Urol 158:1380
Morey AF, Kizer W (2006) Proximal bulbar urethro-plasty via extended anastomotic approach—what are the limits? J Urol 175:2145–2149
Jordan GH, Virasoro R, Eltahawy EA (2006) Reconstruction and management of posterior ure-thral and straddle injuries of the urethra. Urol Clin North Am 33:97–109
Chapple C, Barbagli G, Jordan G, Mundy AR, Rodrigues-Netto N, Pansadoro V, McAninch JW (2004) Consensus statement on urethral trauma. BJU Int 93:1195
Mouraviev VB, Santucci R (2005) Cadaveric anatomy of pelvic fracture urethral distraction injury: most injuries are distal to the external urinary sphincter. J Urol 173:869–872
Morey AF, McAninch JW (1997) Reconstruction of posterior urethral disruption injuries: outcome analysis in 82 patients. J Urol 157:506
Brandes S (2006) Initial management of anterior and posterior urethral injuries. Urol Clin North Am 33:87
Koraitim MM (2005) On the art of anastomotic posterior urethroplasty: a 27-year experience. J Urol 173:135
Mouraviev VB, Coburn M, Santucci RA.(2005) The treatment of posterior urethral disruption associated with pelvic fractures: comparative experience of early realignment versus delayed urethroplasty. J Urol 173:873–876
Mundy AR (1996) Urethroplasty for posterior ure-thral strictures. Br J Urol 78:243
Pratap A, A. C., Tiwari A, Bhattarai BK, Pandit RK, Anchal N (2006) Complex posterior urethral disruptions: management by combined abdominal transpubic perineal urethroplasty. J Urol 175:1751
Anema JG, Morey AF, McAninch JW, et al.(2000) Complications related to the high lithotomy position during urethral reconstruction. J Urol 164:360
Koraitim MM (1996) Pelvic fracture urethral injuries: evaluation of various methods of management. J Urol 156:1288
Berger AP, D. M., Bartsch G, Steiner H, Varkarakis J, Gozzi C (2005) A comparison of one-stage procedures for post-traumatic urethral stricture repair. BJU Int 95,1299
Netto Junior NR, Lemos GC, Claro JF (1989) Internal urethrotomy as a complementary method after urethroplasties for posterior urethral stenosis. J Urol 141:50
Dhabuwala CB, Hamid S, Katsikas DM, et al.(1990) Impotence following delayed repair of prostatomem-branous urethral disruption. J Urol 144:677
Flynn BJ, Delvecchio FC, Webster GD (2003) Perineal repair of pelvic fracture urethral distraction defects: experience in 120 patients during the last 10 years. J Urol 170:1877
Armenakas NA, McAninch JW, Lue TF, et al. (1993) Posttraumatic impotence: magnetic resonance imaging and duplex ultrasound in diagnosis and management. J Urol 149:1272
Shenfeld OZ, Verstandig AG, Kiselgorf D, et al. (2002) Erectile dysfuction after pelvic fractures: Is it neurogenic or arteriogenic? J Urol 167
Aboseif SR, Lue TF (1996) Impotence after urethral injury, in Traumatic and reconstructive urology. Philadelphia, W.B. Saunders Company, pp 455–462
Andrich DE, Mundy AR (2001) The nature of urethral injury in cases of pelvic fracture urethral trauma. J Urol 165:1492
MacDonald MF, Santucci RA (2005) Review and treatment algorithm of open surgical techniques for management of urethral strictures. Urology 65:9
Wessells H, Morey AF, McAninch JW (1997) Single stage reconstruction of complex anterior urethral strictures: combined tissue transfer techniques. J Urol 157:1271–1274
Price DT, Vieweg J, Roland F, Coetzee L, Spalding T, Iselin C, Paulson DF (1998) Transient lower extremity neurapraxia associated with radical peri-neal prostatectomy: a complication of the exaggerated lithotomy position. J Urol 160:1376
Angermeier KW, Jordan GH (1994) Complications of the exaggerated lithotomy position: a review of 177 cases. J Urol 151:866
el-Kasaby AW, Alla MF, Noweir A, et al. (1996) One-stage anterior urethroplasty. J Urol 156:975
Lindell O, Borkowski J, Noll F, et al. (1993) Urethral stricture repair: results in 179 patients. Scand J Urol Nephrol 27:241
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Appendix
Appendix
1.1 Preferred Instruments and Suture of RA Santucci
1.1.1 Specialty Instruments
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8 inch Debakey needle driver
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7 inch serrated curve fine Metzenbaum scissors (Sontec, Maxicut, Englewood, CO)
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Andrews suction tip
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Bougies a boule
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7.75 inch fine tipped Debakey forceps × 2
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3.5 inch Bishop Harmon forceps
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6.75 inch serrated straight Mayo scissors (Sontec Maxicut, Englewood, CO)
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40 mm eye calipers
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Jordan retractor system (C&S Surgical, Slidell, LA) for Bookwalter retractor system (Codman, Raynam, MA)
1.1.2 General Instruments
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19F Rigid cystoscope
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22F Red Robinson catheter
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Bipolar and monopolar cautery
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0.5% bupivacaine (Marcaine/Sensorcaine)
1.1.3 Suture
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5-0 and 6-0 PDS (glycolic acid) or Maxon (poly-dioxanone)
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General sutures 2-0, 3-0, 4-0 Vicryl (polyglycolic acid and 2-0 chromic gut on a SH needle.
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Al-Qudah, H.S., Al-Omar, O., Santucci, R.A. (2008). Complications of Urethroplasty. In: Brandes, S.B. (eds) Urethral Reconstructive Surgery. Current Clinical Urology. Humana Press. https://doi.org/10.1007/978-1-59745-103-1_19
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DOI: https://doi.org/10.1007/978-1-59745-103-1_19
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