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Surgical Outcome of Excision and End-to-End Anastomosis for Bulbar Urethral Stricture

PURPOSE: Although direct-vision internal urethrotomy can be performed for the management of short, bulbar urethral strictures, excision and end-to-end anastomosis remains the best procedure to guarantee a high success rate. We performed a retrospective evaluation of patients who underwent bulbar end...

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Autores principales: Suh, Jun-Gyo, Choi, Woo Suk, Paick, Jae-Seung, Kim, Soo Woong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Urological Association 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715707/
https://www.ncbi.nlm.nih.gov/pubmed/23878686
http://dx.doi.org/10.4111/kju.2013.54.7.442
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author Suh, Jun-Gyo
Choi, Woo Suk
Paick, Jae-Seung
Kim, Soo Woong
author_facet Suh, Jun-Gyo
Choi, Woo Suk
Paick, Jae-Seung
Kim, Soo Woong
author_sort Suh, Jun-Gyo
collection PubMed
description PURPOSE: Although direct-vision internal urethrotomy can be performed for the management of short, bulbar urethral strictures, excision and end-to-end anastomosis remains the best procedure to guarantee a high success rate. We performed a retrospective evaluation of patients who underwent bulbar end-to-end anastomosis to assess the factors affecting surgical outcome. MATERIALS AND METHODS: We reviewed 33 patients with an average age of 55 years who underwent bulbar end-to-end anastomosis. Stricture etiology was blunt perineal trauma (54.6%), iatrogenic (24.2%), idiopathic (12.1%), and infection (9.1%). A total of 21 patients (63.6%) underwent urethrotomy, dilation, or multiple treatments before referral to our center. Clinical outcome was considered a treatment failure when any postoperative instrumentation was needed. RESULTS: Mean operation time was 151 minutes (range, 100 to 215 minutes) and mean excised stricture length was 1.5 cm (range, 0.8 to 2.3 cm). At a mean follow-up of 42.6 months (range, 8 to 96 months), 29 patients (87.9%) were symptom-free and required no further procedure. Strictures recurred in 4 patients (12.1%) within 5 months after surgery. Of four recurrences, one patient was managed successfully by urethrotomy, whereas the remaining three did not respond to urethrotomy or dilation and required additional urethroplasty. The recurrence rate was significantly higher in the patients with nontraumatic causes (iatrogenic in three, infection in one patient) than in the patients with traumatic etiology. CONCLUSIONS: Excision and end-to-end anastomosis for short, bulbar urethral stricture has an acceptable success rate of 87.9%. However, careful consideration is needed to decide on the surgical procedure if the stricture etiology is nontraumatic.
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spelling pubmed-37157072013-07-22 Surgical Outcome of Excision and End-to-End Anastomosis for Bulbar Urethral Stricture Suh, Jun-Gyo Choi, Woo Suk Paick, Jae-Seung Kim, Soo Woong Korean J Urol Original Article PURPOSE: Although direct-vision internal urethrotomy can be performed for the management of short, bulbar urethral strictures, excision and end-to-end anastomosis remains the best procedure to guarantee a high success rate. We performed a retrospective evaluation of patients who underwent bulbar end-to-end anastomosis to assess the factors affecting surgical outcome. MATERIALS AND METHODS: We reviewed 33 patients with an average age of 55 years who underwent bulbar end-to-end anastomosis. Stricture etiology was blunt perineal trauma (54.6%), iatrogenic (24.2%), idiopathic (12.1%), and infection (9.1%). A total of 21 patients (63.6%) underwent urethrotomy, dilation, or multiple treatments before referral to our center. Clinical outcome was considered a treatment failure when any postoperative instrumentation was needed. RESULTS: Mean operation time was 151 minutes (range, 100 to 215 minutes) and mean excised stricture length was 1.5 cm (range, 0.8 to 2.3 cm). At a mean follow-up of 42.6 months (range, 8 to 96 months), 29 patients (87.9%) were symptom-free and required no further procedure. Strictures recurred in 4 patients (12.1%) within 5 months after surgery. Of four recurrences, one patient was managed successfully by urethrotomy, whereas the remaining three did not respond to urethrotomy or dilation and required additional urethroplasty. The recurrence rate was significantly higher in the patients with nontraumatic causes (iatrogenic in three, infection in one patient) than in the patients with traumatic etiology. CONCLUSIONS: Excision and end-to-end anastomosis for short, bulbar urethral stricture has an acceptable success rate of 87.9%. However, careful consideration is needed to decide on the surgical procedure if the stricture etiology is nontraumatic. The Korean Urological Association 2013-07 2013-07-15 /pmc/articles/PMC3715707/ /pubmed/23878686 http://dx.doi.org/10.4111/kju.2013.54.7.442 Text en © The Korean Urological Association, 2013 http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Suh, Jun-Gyo
Choi, Woo Suk
Paick, Jae-Seung
Kim, Soo Woong
Surgical Outcome of Excision and End-to-End Anastomosis for Bulbar Urethral Stricture
title Surgical Outcome of Excision and End-to-End Anastomosis for Bulbar Urethral Stricture
title_full Surgical Outcome of Excision and End-to-End Anastomosis for Bulbar Urethral Stricture
title_fullStr Surgical Outcome of Excision and End-to-End Anastomosis for Bulbar Urethral Stricture
title_full_unstemmed Surgical Outcome of Excision and End-to-End Anastomosis for Bulbar Urethral Stricture
title_short Surgical Outcome of Excision and End-to-End Anastomosis for Bulbar Urethral Stricture
title_sort surgical outcome of excision and end-to-end anastomosis for bulbar urethral stricture
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715707/
https://www.ncbi.nlm.nih.gov/pubmed/23878686
http://dx.doi.org/10.4111/kju.2013.54.7.442
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