Management of postoperative obstruction after bulboprostatic anastomotic urethroplasty for membranous urethral defects secondary to pelvic fracture

OBJECTIVE: To present our experience in the management of postoperative obstruction after bulboprostatic anastomotic urethroplasty for post-traumatic membranous urethral defects secondary to pelvic fracture. MATERIAL AND METHODS: Between 1979 and 1998 we managed 25 patients with postoperative posterior urethral obstruction after bulboprostatic anastomotic urethroplasty. Of these patients, 17 had undergone one repair and 8 had undergone more than one repair. One case had multiple perineal fistulae. Visual urethrotomy was done in 3 patients, 1 had cross union at the site of the anastomosis, and the other 2 had short passable strictures. In cases of obliterated strictures, bulboprostatic anastomosis was done in 6 patients via the perineal route and in 10 patients via the transpubic route. In 6 patients the urethral obstruction was due to new bone formation (callus) in the pubic gap (after pubectomy) pressing on the anastomatic line, and these cases were treated by removal of the callus. RESULTS: After 1-6 years of follow up (mean 3.16 years) the outcome of the 3 patients who underwent visual urethrotomy was good. Eleven of the 16 patients who underwent anastomotic urethroplasty (68.7%) void well, 2 patients had fair results and the remaining 3 (18.7%) had restenosis. In the 6 patients who had new bone formation in the pubic gap, the obstruction was relieved by removal of the callus. CONCLUSIONS: Visual urethrotomy is limited to very short passable urethral strictures, we do not recommend cutting on the light. End-to-end anastomosis was performed in obliterated strictures. Removal of the new bone formation from the pubectomy gap relieved the urethral obstruction.