U-shaped prostatobulbar anastomosis for urethral injury after pelvic trauma

We describe a technique of U-shaped bulboprostatic anastomosis for urethral injury after pelvic trauma.

Sixty-eight male patients were included in our study. Suprapubic cystostomy was carried out initially, followed by U-shaped prostatobulbar anastomosis after 6-12 weeks. Follow ups were carried out at 6, 12 and 18 months by assessing patient satisfaction rates along with preoperative and postoperative urethrogram, uroflowmetry and labelled as good, fair and poor. The surgical technique used was as follows: after an inverted Y-shaped skin incision, subcutaneous tissue and Colle's fascia was opened. Bulbospongiosum was mobilized to gain access to the stricture membranous urethra, which was excised and the bulbar urethra freed. A sound was passed through the suprapubic cystostomy and complete resection of the scar over the tip of the sound was carried out. A silicon catheter was then passed into the bladder and the anastomosis was completed in a 'U' shape; that is, there were no stitches from the 10 to the 2 o'clock position.

Good and fair results were considered as successful. Overall success rate was 97.05% immediately and after 6 months, but decreased to 95.6% at 12 months and 93.6% at 18 months.

U-shaped end-to-end prostatobulbar anastomosis markedly decreases the chance of restenosis and impotence.