Reconstruction of Posterior Urethral Disruption Injuries: Outcome Analysis in 82 Patients

PURPOSE: We sought to identify the long-term success rate of perineal anastomotic reconstruction for posterior urethral disruption. MATERIALS AND METHODS: We reviewed the records of 82 patients with traumatic prostatomembranous urethral strictures who underwent perineal anastomotic urethroplasty by 1 surgeon. RESULTS: Excision of fibrosis with simple perineal anastomosis was performed in 52 patients (63%), while pubectomy was required in 30 (37%) to obtain a tension-free anastomosis. Median followup was longer than 1 year. Potency improved from 46% before reconstruction to 62% postoperatively. Nine patients (11%) required 1 endoscopic urethrotomy after urethroplasty to improve flow rate and this procedure was successful in 8 (88%). In 3 patients (3%) urethroplasty ultimately failed and they remained untreated because of insurmountable co-morbidity. Overall, long-term success was observed in 79 patients (97%). CONCLUSIONS: Excellent long-term results can be expected from anastomotic urethroplasty in patients with traumatic posterior urethral strictures. Subsequent urethrotomy, when required, has a high likelihood of success. A significant number of patients regain potency after urethral reconstruction. Persistent impotence probably reflects the severity of pelvic trauma.