Impact of anastomotic urethroplasty on urinary continence in men

ObjectiveThe study aimed primarily to evaluate urethral patency and continence following anastomotic urethroplasty, as well as the quality of life of the patient as the secondary outcome.Materials and methodsA retrospective study was conducted that included 104 adult male patients in whom perineal anastomotic urethroplasty had been performed for post-traumatic urethral stricture with postoperative follow-up for at least 6 months. Ninety-five (91.4%) patients presented with an in-dwelling suprapubic catheter. Thirty-eight (36.6%) patients had heavy pyuria that was adequately treated before the procedure. Escherichia coli was the most frequently isolated organism (36.6%).ResultsThe mean age of the patients was 30.85 years (range = 18–71 ± 12 years). Sixty-eight patients had strictures 10–20 mm in length (65.4%) and only four (3.9%) patients had a stricture that was larger than 40 mm. All procedures had been carried out through perineal incision. Fifty-eight (67.4%) patients had normal urethral flow on retrograde urethrogram after the procedure, and the global success rate rose to 93% after a secondary procedure (urethroscopic dilatation under anesthesia or direct visual internal urethrotomy). The stricture with a mean length of 24.7 ± 15.2 mm was the only statistically significant predictor of failure of the procedure (P < 0.001). Only two (2.5%) patients suffered stress urinary incontinence with patent urethra and kept using condoms or pads following the procedure. These patients were managed with a bulbourethral sling and finally were continent.ConclusionStricture length is the only statistically significant predictor of success or failure of anastomotic urethroplasty. Stress urinary incontinence has low incidence following this procedure, whereas bulbourethral sling appears to be a reasonable treatment option. Successful repair of the urethral stricture has a positive impact on the quality of life of the patients following urethroplasty.