Synchronous urethral stricture reconstruction via 1-stage ascending approach: rationale and results

We present our experience with the reconstruction of synchronous urethral strictures.

Of 482 anterior urethroplasties performed by a single surgeon between 1997 and 2008 we identified and reviewed 30 patients who underwent reconstruction for multiple separate strictures. An ascending approach from distal to proximal was used and all repairs were completed at 1 stage. A total of 13 combinations of techniques were used to complete the repairs. A 2-phase technique was used in which the patient remained supine during buccal mucosa harvest and repair of strictures distal to the penoscrotal junction, and was then repositioned into the high lithotomy position as needed for stricture repair in the bulbar urethra. In each case normal intervening urethra was preserved intact. The number, length and location of strictures, operative time and patient outcomes were evaluated.

No position related complications occurred during or after surgery despite a mean operative time of 4.5 hours (range 2.5 to 6.4). No infectious wound complications were reported despite repositioning the legs to the high lithotomy position. Three patients (10%) were known to have required treatment for recurrent stricture after surgery.

One-stage reconstruction for synchronous urethral strictures may be safely and effectively performed using a systematic, ascending reconstructive approach with creative application of tissue transfer techniques. Decreasing patient time in the high lithotomy position appears to prevent related lower extremity complications.