Transpubic urethroplasty for complex posterior urethral strictures: a single center experience.

Objective: To review our experience and outcome of transpubic urethroplasty for complex posterior urethral strictures.

Methods: 19 patients, mean age 17.8 (6-35) years, were treated with transpubic urethroplasty over the last 6 years. All had traumatic etiology (15 due to road traffic accidents and 4 due to falls from height). Mean stricture length was 4.4 (3.0-6.0) cm. All had a history of some intervention earlier. Three had rectourethral fistula, and 2 sinus tract in perineum which was connected to the periurethral cavity. One had a long fistulous tract connected through the anus to the anterior abdominal wall. One patient each had urethrocutaneous fistula, periurethral cavity and osteomyelitis of the pubic bone.

Results: 16 of 19 (84.2%) patients had excellent outcomes with no evidence of stricture. Three had acceptable outcomes with some evidence of stricture. The mean operative time was 3.2 (2.5-4.0) h and average blood loss was 650 (500-900) ml. The mean hospital stay was 7.6 (6-12) days and average follow-up was 30 (7-66) months. Two patients developed mild wound infection. One patient each developed epididymoorchitis, perineal hematoma, fecal fistula and urine leak. One patient failed to void, and one patient developed erectile dysfunction.

Conclusions: Transpubic urethroplasty is an excellent approach for patients with complex posterior urethral strictures.