Comparison of open and endoscopic treatment of posttraumatic posterior urethral strictures

The purpose of this study was to compare the invasiveness, morbidity, and outcomes of open versus endoscopic treatment of posttraumatic posterior urethral strictures. We compared two groups of men with strictures of the posterior urethra after pelvic fracture: Group I (n = 6) underwent cut-to-the-light procedures before 1995, and group II (n = 9) underwent perineal anastomotic urethroplasty after 1995. The operating time and blood loss were lower in the endoscopic group, but no other significant differences in morbidity or invasiveness were found. All six patients in group I required multiple secondary procedures: Three reached a stable voiding pattern after a mean of three interventions, two required subsequent urethroplasty, and one was lost to long-term follow-up. Normal voiding was achieved in all group II patients, although two (22%) required single internal urethrotomy within 3 months after surgery. The data show the comparable morbidity of open urethroplasty and cut-to-the-light procedures and support an aggressive surgical approach for the delayed treatment of posttraumatic posterior urethral strictures. Other than a reduced operating time, endoscopic procedures offered no compelling advantage over surgical reconstruction.