Transperineal bulbo‐prostatic anastomosis for posterior urethral stricture associated with false passage: a single‐centre experience

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The emergency treatment of patients with PFUDD in developing countries is not currently codified and the majority of these patients have been treated using incorrect procedures that add iatrogenic damage to the trauma. Sometimes urethral dilatation gruffly and repeatedly wound lead to formation of urethral false passage which results in infection and incontinence. The treatment of urethral false passage is still a major challenge for urologists. False passage can lead to prolonged unhealed infections, increase the scar around the urethra, increasing stricture significantly. If preoperative examination was careless, it leads to identify false passage difficultly intra‐operative, the variation of direction when the curved sound was used as internal guidance, anastomosis between distal urethra and bladder wall near the orificium urethrae internum, leading to surgical failure. Cystourethrogram, flexible cystocopy pre‐operatively and dissect urethral bulb carefully are key points of urethroplasty for posterior urethral stricture with false passage. Then to pass a curved sound via the suprapubic tract into the posterior urethra to act as a guide for subsequent excision of all scar tissue. OBJECTIVE • To evaluate the management of traumatic posterior urethral stricture associated with false passage, as this remains a challenge for urologists. PATIENTS AND METHODS • From January 2000 to February 2010, 19 patients (mean (range) age 34 [25–52] years) with traumatic posterior urethral obliteration associated with false passage were evaluated and treated at our centre. • All patients underwent perineal excision and primary anastomotic urethroplasty using cystoscopy by the suprapubic route to insert a guidewire into the original bladder neck, allowing exposure of the normal posterior urethra. • Patients underwent voiding cysto‐urethrography 1 month after the procedure. When symptoms of decreased force of stream were present and uroflowmetry was <15 mL/s, urethrography and urethroscopy were repeated. • Clinical outcome was considered a failure when any postoperative instrumentation was needed, including dilatation. RESULTS • The mean (range) follow‐up was 12 (9–14) months. The overall success rate was 84%. • Three patients (16%) with persistent voiding difficulty developed a short anastomotic stricture 1–3 months after surgery. • The mean maximum urinary flow rate after surgery was 20.01 mL/s and no patient had urinary incontinence. CONCLUSION • The preoperative use of flexible cystoscopy via the suprapubic route represented a successful key point of urethroplasty for posterior urethral stricture associated with false passage.