The Comparable Results of Minimally Invasive Therapy versus Primary Anastomosis in the Management of Partial Posterior Urethral Stricture

Abstract

BACKGROUND: Urinary retention has many etiologies. One of them is urethral stricture or the narrowing of urethral lumen due to fibrotic tissue. Urethral stricture is considered a medical emergency condition because it might cause complications in some extent. At present, there are several surgical techniques introduced with their advantages and disadvantages.
 AIM: The study aimed to compare the outcome of minimal invasive therapy (MIT) or excision and primary anastomosis (EPA) techniques.
 METHODS: A retrospective cohort study was performed on patients with partial posterior urethral stricture. The inclusion criteria were all patients with partial posterior urethral stricture who underwent MIT or EPA from 2014 to 2018. The data of International Prostate Symptom Score (IPSS), quality of life (QoL), urinary peak flow rate (Qmax), urine residue, erection hardness score, clean intermittent catheterization (CIC), recurrence, and penile perception scores (PPS) were obtained and analyzed postoperatively.
 RESULTS: Thirty-four patients included in the study, consisted of 17 patients for each group. EPA group showed significantly superior to MIT in Qmax (p < 0.001), CIC (p = 0.007), and PPS score (p = 0.003). However, no significance differences were found in QoL (p = 0.071), IPSS score (p = 0.083), bladder urine residue (p = 0.688), recurrence (p = 0.225), and erectile function (p = 0.303).
 CONCLUSION: EPA may be superior to MIT in some aspect. However, other advantages of MIT could be outweighed EPA techniques, such as QoL, IPSS, bladder urine residual, stricture recurrence, and erectile function. MIT still has a place to be the first-line management of partial posterior urethral stricture.

Treatment of panurethral strictures using one side dissection dorsal onlay buccal mucosal graft urethroplasty

“…4 Most panurethral strictures in developing countries were caused by lichen sclerosis and iatrogenic factors, such as urethral catheterisation, cystourethroscopy, transurethral resection, and previous urethral surgeries. 4,5 Other reports found trauma and sexually transmitted diseases are the most common factors. 7 The urethral substitution was priorly done by using flap and grafts from the genital area.…”

“…The urethral stricture was defined as the narrowing of the calibre of the due to the formation of scar tissues surrounding the urethra. 5,6 Meanwhile, a panurethral stricture is a urethral stricture involving the entire urethra from the meatus until the proximal bulbar. 4 Most panurethral strictures in developing countries were caused by lichen sclerosis and iatrogenic factors, such as urethral catheterisation, cystourethroscopy, transurethral resection, and previous urethral surgeries.…”