Skip to main content
SpringerLink
Log in

Complications of Urethroplasty

  • Chapter
Urethral Reconstructive Surgery

Part of the book series: Current Clinical Urology ((CCU))

  • 1710 Accesses

Summary

Urethroplasty has excellent success rates against urethral stricture that far exceed that found with direct visual internal urethrotomy (DVIU) and dilation. Different forms of urethroplasty were employed including, buccal mucosal (BM), fasciocutaneous and anastomotic urethroplasty. Complications of urethroplasty are directly related to location of stricture, surgical technique, type of substitution tissue, and length of stricture. These complications range from mild and temporary to severe and complicated ones, which result in failure of urethroplasty. We present in this chapter an extensive review of the literature for complications of urethroplasty. Limitations in current published papers are the lack of a universally accepted definition of treatment failure and that reports are mixed complications for heterogeneous groups of strictures, treated by different modalities and surgeons.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 199.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Al-Qudah HS, Santuci RA (2005) Extended complications of urethroplasty. Int Braz J Urol 31:315

    PubMed  Google Scholar 

  2. Flynn BJ, Delvecchio FC, Webster GD (2002) Perineal repair of posterior urethral stricture and defect: Experience in 79 cases in the last 5-years. J Urol 167

    Google Scholar 

  3. Santucci RA, Mario LA, McAninch JW (2002) Anastomotic urethroplasty for bulbar urethral stricture: analysis of 168 patients. J Urol 167:1715

    Article  PubMed  Google Scholar 

  4. Elliott SP, Metro MJ, McAninch JW (2003) Long-term followup of the ventrally placed buccal mucosa onlay graft in bulbar urethral reconstruction. J Urol 169:1754

    Article  PubMed  Google Scholar 

  5. Pansadoro V, Emiliozzi P, Gaffi M, et al. (2003) Buccal mucosa urethroplasty in the treatment of bulbar urethral strictures. Urology 61:1008

    Article  PubMed  Google Scholar 

  6. Andrich DE, Leach CJ, Mundy AR (2001) The Barbagli procedure gives the best results for patch urethroplasty of the bulbar urethra. BJU Int 88:385

    Article  PubMed  CAS  Google Scholar 

  7. Heyns CF, Steenkamp JW, De Kock ML et al. (1998) Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful? J Urol 160:356

    Article  PubMed  CAS  Google Scholar 

  8. Pansadoro V, Emiliozzi P (1996) Internal urethrotomy in the management of anterior urethral strictures: long-term followup. J Urol 156:73

    Article  PubMed  CAS  Google Scholar 

  9. Greenwell TJ, Castle C, Andrich DE et al. (2004) Repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor cost-effective. J Urol 172:275

    Article  PubMed  CAS  Google Scholar 

  10. Heyns CF, S. J., De Kock ML,Whitaker P (1998) Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful? J Urol 160:356

    Article  PubMed  CAS  Google Scholar 

  11. Jakse G, Marberger, H (1986) Excisional repair of urethral stricture. Follow-up of 90 patients. Urology 27:233

    Article  PubMed  CAS  Google Scholar 

  12. Jezior JR, Schlossberg SM (2002) Excision and primary anastomosis for anterior urethral stricture. Urol Clin North Am 29:373–380

    Article  PubMed  Google Scholar 

  13. Martinez-Pineiro JA, Carcamo P, Garcia Matres MJ, et al. (1997) Excision and anastomotic repair for urethral stricture disease: experience with 150 cases. Eur Urol 32:433

    PubMed  CAS  Google Scholar 

  14. Azoury BS, Freiha FS (1976) Excision of urethral stricture and end to end anastomosis. Urology 8:138

    Article  PubMed  CAS  Google Scholar 

  15. Schlossberg SM (2000) Anastomotic urethral reconstruction. Presented at the American Urologic Association postgraduate course, Atlanta, Georgia

    Google Scholar 

  16. Barbagli G, G. G, Palminteri E, Lazzeri M. (2006) Anastomotic fibrous ring as cause of stricture recurrence after bulbar onlay graft urethroplasty. J Urol 176:614

    Article  PubMed  Google Scholar 

  17. Wessells H, McAninch JW (1996) Use of free grafts in urethral stricture reconstruction. J Urol 155

    Google Scholar 

  18. Andrich DE, Mundy AR (2001) Substitution urethroplasty with buccal mucosal-free grafts. J Urol 165

    Google Scholar 

  19. Barbagli G, Selli C, Tosto A et al. (1996) Dorsal free graft urethroplasty. J Urol 155:123

    Article  PubMed  CAS  Google Scholar 

  20. Palminteri E, Lazzeri M, Guazzoni G, Turini D, Barbagli G (2002) New 2-stage buccal mucosal graft urethroplasty. J Urol 167:130

    Article  PubMed  Google Scholar 

  21. Dubey D, Kumar A., Mandhani A, Srivastava A, Kapoor R, Bhandari M (2005) Buccal mucosal urethroplasty: a versatile technique for all urethral segments. BJU Int. 95:625–629

    Article  PubMed  Google Scholar 

  22. Gupta NP, A. M., Dogra PN, Tandon S (2004) Dorsal buccal mucosal graft urethroplasty by a ventral sagittal urethrotomy and minimal-access perineal approach for anterior urethral stricture. BJU Int 93:1287

    Article  PubMed  CAS  Google Scholar 

  23. Fichtner J, Filipas D, Fisch M, et al. (2004) Long-term outcome of ventral buccal mucosa onlay graft urethro-plasty for urethral stricture repair. Urology 64:648

    Article  PubMed  Google Scholar 

  24. Zinman L (2003) The use of buccal mucosal graft onlay in urethral reconstruction. Am J Urol Rev 1:45

    Google Scholar 

  25. el-Kasaby AW, Fath-Alla M, Noweir AM, el-Halaby MR, Zakaria W, el-Beialy MH (1993) The use of buccal mucosa patch graft in the management of anterior urethral strictures. J Urol 149:276–278

    PubMed  CAS  Google Scholar 

  26. Barbagli G, Palminteri E, Guazzoni G, et al. (2005) Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique? J Urol 174:955

    Article  PubMed  Google Scholar 

  27. Dubey D, S. A., Srivastava A, Mandhani A, Kapoor R, Kumar A (2005) Buccal mucosal urethroplasty for balanitis xerotica obliterans related urethral strictures: the outcome of 1 and 2-stage techniques. J Urol 173:463

    Article  PubMed  Google Scholar 

  28. Heinke T, Gerharz EW, Bonfig R, et al. (2003) Ventral onlay urethroplasty using buccal mucosa for complex stricture repair. Urology 61:1004

    Article  PubMed  Google Scholar 

  29. Elliott SP, Metro MJ, McAninch JW (2002) Long-term follow-up of the ventrally placed buccal mucosa onlay graft in bulbar urethral reconstruction. J Urol 167

    Google Scholar 

  30. Andrich DE, Dunglison N, Greenwell TJ, et al. (2003) The long-term results of urethroplasty. J Urol 170:90

    Article  PubMed  CAS  Google Scholar 

  31. Kane CJ, Tarman GJ, Summerton DJ, et al. (2002) Multi-institutional experience with buccal mucosa onlay urethroplasty for bulbar urethral reconstruction. J Urol 167:1314

    Article  PubMed  Google Scholar 

  32. Kellner DS, Fracchia JA, Armenakas NA (2004) Ventral onlay buccal mucosal grafts for anterior urethral strictures: long-term followup. J Urol 171:726

    Article  PubMed  Google Scholar 

  33. Barbagli G, P. E., Guazzoni G, Montorsi F, Turini D, Lazzeri M. (2005) Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique? J Urol 174:955

    Article  PubMed  Google Scholar 

  34. Bhargava S, C. C. (2004) Buccal mucosal ure-throplasty: is it the new gold standard? BJU Int 93:1191

    Article  PubMed  CAS  Google Scholar 

  35. Venn SN, Mundy AR (1998) Early experience with the use of buccal mucosa for substitution urethro-plasty. Br J Urol 81:738

    PubMed  CAS  Google Scholar 

  36. Al-Qudah HS, C. A., Santucci RA. (2005) Early catheter removal after anterior anastomotic (3 days) and ventral buccal mucosal onlay (7 days) urethro-plasty. Int Brazil J Urol 31:459

    Google Scholar 

  37. Coursey JW, Morey AF, McAninch JW et al.(2001) Erectile function after anterior urethroplasty. J Urol 166:2273

    Article  PubMed  CAS  Google Scholar 

  38. Barbagli G, Selli C, di Cello V, et al. (1996) A one-stage dorsal free-graft urethroplasty for bulbar urethral strictures. Br J Urol 78:929

    PubMed  CAS  Google Scholar 

  39. Yucel S, B. L (2003) Neuroanatomy of the male urethra and perineum. BJU Int 92:624

    Article  PubMed  CAS  Google Scholar 

  40. Andrich DE, Mundy AR (2000) Urethral strictures and their surgical treatment. BJU Int 86:571

    Article  PubMed  CAS  Google Scholar 

  41. Dubey D, Kumar A, Bansal P, Srivastava A, Kapoor R, Mandhani A, Bhandari M. (2003) Substitution urethroplasty for anterior urethral strictures: a critical appraisal of various techniques. BJU Int 91:215–218

    Article  PubMed  CAS  Google Scholar 

  42. Dublin N, Stewart LH (2004) Oral complications after buccal mucosal graft harvest for urethroplasty. BJU Int 94:867–869

    Article  PubMed  Google Scholar 

  43. Raber M, Naspro R, Scapaticci E, Salonia A, Scattoni V, Mazzoccoli B, Guazzoni G, Rigatti P, Montorsi F (2005) Dorsal onlay graft urethroplasty using penile skin or buccal mucosa for repair of bulbar urethral stricture: results of a prospective single center study. Eur Urol 48:1013–1017

    Article  PubMed  Google Scholar 

  44. Wood DN, Allen SE, Andrich DE, Greenwell TJ, Mundy AR. (2004) The morbidity of buccal mucosal graft harvest for urethroplasty and the effect of nonclosure of the graft harvest site on postoperative pain. J Urol 172:580–583

    Article  PubMed  CAS  Google Scholar 

  45. Morey AF, McAninch JW (1996) Technique of harvesting buccal mucosa for urethral reconstruction. J Urol 155:1696

    Article  PubMed  CAS  Google Scholar 

  46. Eppley BL, Keating M, Rink R. (1997) A buccal mucosal harvesting technique for urethral reconstruction. J Urol 157:1268–1270

    Article  PubMed  CAS  Google Scholar 

  47. Kamp S, Knoll T, Osman M, Hacker A, Michel MS, Alken P. (2005) Donor-site morbidity in buccal mucosa urethroplasty: lower lip or inner cheek? BJU Int 96:619–623

    Article  PubMed  Google Scholar 

  48. Tolstunov L, Pogrel MA, McAninch JW (1997) Intraoral morbidity following free buccal mucosal graft harvesting for urethroplasty. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84:480–482

    Article  PubMed  CAS  Google Scholar 

  49. Barbagli G (2004) When and how to use buccal mucosa grafts in penile and bulbar urethroplasty. Minerva Urol Nefrol 56:189

    PubMed  CAS  Google Scholar 

  50. Meneghini A, Cacciola A, Cavarretta L, et al. (2001) Bulbar urethral stricture repair with buccal mucosa graft urethroplasty. Eur Urol 39:264

    Article  PubMed  CAS  Google Scholar 

  51. Pressman D, G. D. (1953) Reconstruction of the. perineal urethra with a free full thickness skin graft from the prepuce. J Urol 69:677

    Google Scholar 

  52. Jordan GH, Schlossberg SM (2002) Surgery of the penis and urethra, in Walsh P Retik AB, Vaughan ED, et al. (eds) Campbell's urology (ed 8). Philadelphia, Saunders, pp 3886–3954

    Google Scholar 

  53. Mundy AR (1995) The long-term results of skin inlay urethroplasty. Br J Urol 75:59

    Article  PubMed  CAS  Google Scholar 

  54. Koraitim M (2003) Failed posterior urethroplasty: lessons learned. Urology 62:719

    Article  PubMed  Google Scholar 

  55. Greenwell TJ, Venn SN, Mundy AR (1999) Changing practice in anterior urethroplasty. BJU Int 83:631

    Article  PubMed  CAS  Google Scholar 

  56. McAninch JW, Morey AF (1998) Penile circular fasciocutaneous skin flap in 1-stage reconstruction of complex anterior urethral strictures. J Urol 159:1209

    Article  PubMed  CAS  Google Scholar 

  57. Bhandari M, Dubey D, Verma BS (2001) Dorsal or ventral placement of the preputial/penile skin onlay flap for anterior urethral strictures: does it make a difference? BJU Int 88:39

    Article  PubMed  CAS  Google Scholar 

  58. Morey AF, Tran LK, Zinman LM (2000) Q-flap reconstruction of panurethral strictures. BJU Int 86:1039

    Article  PubMed  CAS  Google Scholar 

  59. Mundy AR (1993) Results and complications of urethroplasty and its future. Br J Urol 71:322

    Article  PubMed  CAS  Google Scholar 

  60. Baskin LS, Erol A, Li YW, Cunha GR (1998) Anatomical studies of hypospadias. J Urol 160: 1108–1115

    Article  PubMed  CAS  Google Scholar 

  61. Kessler TM, Fisch M, Heitz M, Olianas R, Schreiter F.(2002) Patient satisfaction with the outcome of surgery for urethral stricture. J Urol 167:2507–2511

    Article  PubMed  Google Scholar 

  62. Micheli E, Ranieri A, Peracchia G, Lembo A. (2002) End-to-end urethroplasty: long-term results. BJU Int 90:68–71

    Article  PubMed  CAS  Google Scholar 

  63. Roehrborn CG, McConnell JD (1994) Analysis of factors contributing to success or failure of 1-stage urethroplasty for urethral stricture disease. J Urol 151:869

    PubMed  CAS  Google Scholar 

  64. Park S, McAninch JW (2004) Straddle injuries to the bulbar urethra: management and outcomes in 78 patients. J Urol 171:722

    Article  PubMed  Google Scholar 

  65. Barbagli G, Palminteri E, Bartoletti R, et al. (1997) Long-term results of anterior and posterior urethro-plasty with actuarial evaluation of the success rates. J Urol 158:1380

    Article  PubMed  CAS  Google Scholar 

  66. Morey AF, Kizer W (2006) Proximal bulbar urethro-plasty via extended anastomotic approach—what are the limits? J Urol 175:2145–2149

    Article  PubMed  Google Scholar 

  67. Jordan GH, Virasoro R, Eltahawy EA (2006) Reconstruction and management of posterior ure-thral and straddle injuries of the urethra. Urol Clin North Am 33:97–109

    Article  PubMed  Google Scholar 

  68. Chapple C, Barbagli G, Jordan G, Mundy AR, Rodrigues-Netto N, Pansadoro V, McAninch JW (2004) Consensus statement on urethral trauma. BJU Int 93:1195

    Article  PubMed  CAS  Google Scholar 

  69. Mouraviev VB, Santucci R (2005) Cadaveric anatomy of pelvic fracture urethral distraction injury: most injuries are distal to the external urinary sphincter. J Urol 173:869–872

    Article  PubMed  Google Scholar 

  70. Morey AF, McAninch JW (1997) Reconstruction of posterior urethral disruption injuries: outcome analysis in 82 patients. J Urol 157:506

    Article  PubMed  CAS  Google Scholar 

  71. Brandes S (2006) Initial management of anterior and posterior urethral injuries. Urol Clin North Am 33:87

    Article  PubMed  Google Scholar 

  72. Koraitim MM (2005) On the art of anastomotic posterior urethroplasty: a 27-year experience. J Urol 173:135

    Article  PubMed  Google Scholar 

  73. Mouraviev VB, Coburn M, Santucci RA.(2005) The treatment of posterior urethral disruption associated with pelvic fractures: comparative experience of early realignment versus delayed urethroplasty. J Urol 173:873–876

    Article  PubMed  Google Scholar 

  74. Mundy AR (1996) Urethroplasty for posterior ure-thral strictures. Br J Urol 78:243

    PubMed  CAS  Google Scholar 

  75. Pratap A, A. C., Tiwari A, Bhattarai BK, Pandit RK, Anchal N (2006) Complex posterior urethral disruptions: management by combined abdominal transpubic perineal urethroplasty. J Urol 175:1751

    Article  PubMed  Google Scholar 

  76. Anema JG, Morey AF, McAninch JW, et al.(2000) Complications related to the high lithotomy position during urethral reconstruction. J Urol 164:360

    Article  PubMed  CAS  Google Scholar 

  77. Koraitim MM (1996) Pelvic fracture urethral injuries: evaluation of various methods of management. J Urol 156:1288

    Article  PubMed  CAS  Google Scholar 

  78. Berger AP, D. M., Bartsch G, Steiner H, Varkarakis J, Gozzi C (2005) A comparison of one-stage procedures for post-traumatic urethral stricture repair. BJU Int 95,1299

    Google Scholar 

  79. Netto Junior NR, Lemos GC, Claro JF (1989) Internal urethrotomy as a complementary method after urethroplasties for posterior urethral stenosis. J Urol 141:50

    PubMed  CAS  Google Scholar 

  80. Dhabuwala CB, Hamid S, Katsikas DM, et al.(1990) Impotence following delayed repair of prostatomem-branous urethral disruption. J Urol 144:677

    PubMed  CAS  Google Scholar 

  81. Flynn BJ, Delvecchio FC, Webster GD (2003) Perineal repair of pelvic fracture urethral distraction defects: experience in 120 patients during the last 10 years. J Urol 170:1877

    Article  PubMed  Google Scholar 

  82. Armenakas NA, McAninch JW, Lue TF, et al. (1993) Posttraumatic impotence: magnetic resonance imaging and duplex ultrasound in diagnosis and management. J Urol 149:1272

    PubMed  CAS  Google Scholar 

  83. Shenfeld OZ, Verstandig AG, Kiselgorf D, et al. (2002) Erectile dysfuction after pelvic fractures: Is it neurogenic or arteriogenic? J Urol 167

    Google Scholar 

  84. Aboseif SR, Lue TF (1996) Impotence after urethral injury, in Traumatic and reconstructive urology. Philadelphia, W.B. Saunders Company, pp 455–462

    Google Scholar 

  85. Andrich DE, Mundy AR (2001) The nature of urethral injury in cases of pelvic fracture urethral trauma. J Urol 165:1492

    Article  PubMed  CAS  Google Scholar 

  86. MacDonald MF, Santucci RA (2005) Review and treatment algorithm of open surgical techniques for management of urethral strictures. Urology 65:9

    Article  PubMed  Google Scholar 

  87. Wessells H, Morey AF, McAninch JW (1997) Single stage reconstruction of complex anterior urethral strictures: combined tissue transfer techniques. J Urol 157:1271–1274

    Article  PubMed  CAS  Google Scholar 

  88. Price DT, Vieweg J, Roland F, Coetzee L, Spalding T, Iselin C, Paulson DF (1998) Transient lower extremity neurapraxia associated with radical peri-neal prostatectomy: a complication of the exaggerated lithotomy position. J Urol 160:1376

    Article  PubMed  CAS  Google Scholar 

  89. Angermeier KW, Jordan GH (1994) Complications of the exaggerated lithotomy position: a review of 177 cases. J Urol 151:866

    PubMed  CAS  Google Scholar 

  90. el-Kasaby AW, Alla MF, Noweir A, et al. (1996) One-stage anterior urethroplasty. J Urol 156:975

    Article  PubMed  CAS  Google Scholar 

  91. Lindell O, Borkowski J, Noll F, et al. (1993) Urethral stricture repair: results in 179 patients. Scand J Urol Nephrol 27:241

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Urology, Department of General Surgery, Jordan University of Science and Technology, School of Medicine, Irbid, Jordan

    Hosam S. Al-Qudah MD

  2. Department of Urology, Wayne State University School of Medicine and Detroit Receiving Hospital, Detroit, MI, USA

    Osama Al-Omar MD & Richard A. Santucci MD

Authors
  1. Hosam S. Al-Qudah MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Osama Al-Omar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard A. Santucci MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA

    Steven B. Brandes M.D., FACS

Appendix

Appendix

1.1 Preferred Instruments and Suture of RA Santucci

1.1.1 Specialty Instruments

  • 8 inch Debakey needle driver

  • 7 inch serrated curve fine Metzenbaum scissors (Sontec, Maxicut, Englewood, CO)

  • Andrews suction tip

  • Bougies a boule

  • 7.75 inch fine tipped Debakey forceps × 2

  • 3.5 inch Bishop Harmon forceps

  • 6.75 inch serrated straight Mayo scissors (Sontec Maxicut, Englewood, CO)

  • 40 mm eye calipers

  • Jordan retractor system (C&S Surgical, Slidell, LA) for Bookwalter retractor system (Codman, Raynam, MA)

1.1.2 General Instruments

  • 19F Rigid cystoscope

  • 22F Red Robinson catheter

  • Bipolar and monopolar cautery

  • 0.5% bupivacaine (Marcaine/Sensorcaine)

1.1.3 Suture

  • 5-0 and 6-0 PDS (glycolic acid) or Maxon (poly-dioxanone)

  • General sutures 2-0, 3-0, 4-0 Vicryl (polyglycolic acid and 2-0 chromic gut on a SH needle.

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Humana Press, a part of Springer Science + Business Media, LLC

About this chapter

Cite this chapter

Al-Qudah, H.S., Al-Omar, O., Santucci, R.A. (2008). Complications of Urethroplasty. In: Brandes, S.B. (eds) Urethral Reconstructive Surgery. Current Clinical Urology. Humana Press. https://doi.org/10.1007/978-1-59745-103-1_19

Download citation

  • DOI: https://doi.org/10.1007/978-1-59745-103-1_19

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-826-3

  • Online ISBN: 978-1-59745-103-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation