Abstract:
Background. Limited data are available on outcomes of the surgical management of inflammatory urethral strictures secondary to infection,
a major cause of stricture. Several shortcomings that need to be addressed have been identified in the past.
Objective. To determine the impact of stricture length, position and degree of obliterative urethral lumen on the surgical outcomes of
corrective procedures for inflammatory anterior urethral strictures.
Methods. This retrospective analysis used the records of patients who presented with proven infective anterior urethral strictures at an
academic hospital from 2007 to 2010. All patients were followed up after 48 months. Urethroplasty outcomes were analysed according to
stricture location and length and effect of urethral obliteration.
Results. The median age of the 174 patients in the study was 47 (range 21 - 86) years. Anastomotic urethroplasty was successful in 59/99
(59.6%) patients. Augmented anastomotic urethroplasty was successful in 11/15 (73.3%) patients. Dorsal onlay buccal mucosa graft
urethroplasty was successful in 23/32 (71.9%) patients, significantly higher than in 2/9 (22.2%) patients who underwent ventral onlay buccal
mucosa graft urethroplasty (p=0.017; hazard ratio 3.4; 95% confidence interval 1.29 - 9.40). The one-stage circular pedicled penile skin-flap
urethroplasty was successful in 1/12 (8.3%) patients. Two-stage urethroplasty was successful in 5/7 (71.4%) patients. A primary component
analysis of the 73 failed procedures showed that stricture length was the main contributor to failure (eigenvalue 1.79; 45%).
Conclusions. Urethroplasty remains a challenge in inflammatory urethral strictures, where stricture length was the main reason for
treatment failure.
