A 40 yr old patient of pelvic injury presents with stricture bulbar urethra of 1.5 cm length. What would be the management?
Anastomotic urethroplasty is the procedure of choice in the totally obliterated bulbar urethra after a straddle injury. The typical scar is 1.5 to 2 cm long and should be completely excised. The proximal and distal urethra can be mobilized for a tension-free, end-to-end anastomosis. This is a highly successful procedure in more than 95% of cases. Endoscopic incision (urethrotomy) through the scar tissue of an obliterated urethra is a hopeless procedure and uniformly fails. Paial urethral narrowing can initially be treated by endoscopic incision with higher success. It is now recognized that repeated urethrotomy and dilation is neither clinically effective nor cost-effective for the treatment of urethral strictures. Fuher, patients who have had repeated endoscopic procedures are also more likely to require complex reconstructive procedures such as grafts" -- Campbell's Urology "Urethroplasty should be considered when the stricture has arisen following trauma, and when a stricture has recurred following endoscopic treatment. "- Bailey Urethroplasty can be of two types: excision and end-to-end anastomosis- done for sho stricture segments (<=2 cm) patch urethroplasty- for longer segments
Urethral dilatation
Excision and end to end urethroplasty
Patch graft urethroplasty
Urethrotomy
Urology