Use of anastomotic urethroplasty with partial pubectomy for posterior urethral obliteration injuries: 10 years experience.

PURPOSE: Management of pelvic trauma-induced posterior urethral disruption due can be quite controversial and challenging. METHODS: Posterior urethral obliteration cases at the membranous urethra (n = 154) were analyzed from January 1997 to December 2006. The mean length of the urethral obliteration was 4.82 +/- 1.1 cm (range 3.5-6 cm). All patients underwent excision and primary bulboprostatic anastomosis with a perineal approach partial pubectomy. RESULTS: The percentage of overall successful surgeries (defined by Qmax values > 15 ml/s) was 85.1%, and the mean Qmax value was 22.94 +/- 5.7 cm/s without post-operative incontinence. Short anastomotic strictures developed 1-3 months post-operatively in 23 cases with persistent voiding difficulties. CONCLUSIONS: Partial pubectomy is a feasible therapeutic option in patients with long urethral obliteration and may provide effective surgical results for post-traumatic posterior urethral strictures.

Evaluation of erectile function after urethral reconstruction: a prospective study.

We conducted a prospective study of erectile dysfunction (ED) after urethral reconstructive surgery, using the 5-item International Index of Erectile Function (IIEF-5), the Sexual Life Quality Questionnaire (SLQQ) and the Quality of Life Questionnaire (QoLQ). Between January 2003 and July 2007, 125 male patients with urethral strictures underwent urethroplasty, and pre- and post-surgery erectile function was assessed using these three questionnaires. A formula to predict the probability of ED after urethroplasty was derived. At 3 months post-operatively, there was a significant decrease in IIEF-5 (16.57 +/- 7.98) and SLQQ scores (28.71 +/- 14.84) compared with pre-operative scores (P < 0.05). However, the IIEF-5 scores rebounded at 6 months post-operatively (17.22 +/- 8.41). Logistical regression analysis showed that the location of the urethral stricture, the recurrence of strictures and the choice of surgical technique were predictive of the post-operative occurrence of ED. This study identified the clinical risk factors for ED after urethroplasty. Posterior urethral stricture and end-to-end anastomosis were found to have a strong relationship with erectile function. The logistical model derived in this study may be applied to clinical decision algorithms for patients with urethral strictures.