Johanson's staged urethroplasty revisited in the salvage treatment of 68 complex urethral stricture patients: presentation of total urethroplasty

BACKGROUND: To show our experience with the staged Johanson's urethroplasty as a salvage treatment of difficult and complicated groups of patients, and to present the total urethroplasty technique. MATERIAL AND METHODS: During a 12-year period, 68 men with urethral stricture underwent the staged Johanson's urethroplasty. 51 had war-related injuries (75%) resulting in an unhealthy perineal and genital skin with fistulae and/or scarring. 35 patients (52%) had other urethral or vesical problems. 60 patients (88%) had long (0.5-4 cm), multiple or impassable strictures. 58 patients (85%) had strictures of the pendulous urethra. The second stage was performed 2-3 months after the first. Both stages of Johanson's urethroplasty were protected by a stab suprapubic catheter for 3 weeks. Patients were followed up for 23-82 months (mean 52.5). RESULTS: All patients but 4 had improved urine flow (best Qmax ranged between 13.2 and 31.8 ml/s; mean 17.4). 4 patients (6%) needed a revision because of fistula formation or recurrence and 6 patients (9%) developed urinary tract infection postoperatively. CONCLUSIONS: The staged Johanson's urethroplasty is a good treatment for the difficult and complicated urethral strictures which are not suitable for optical urethrotomy, especially those in the pendulous part. In strictures involving all parts of the urethra total urethroplasty could be performed.