Comprehensive analysis and urethroscopic evaluation of "U" shaped prostatobulbar anastomotic urethroplasty

To evaluate efficacy of "U" shaped prostatobulbar anastamosis [USPBA] in a posterior urethral stricture along with its urethroscopic evaluation to let us assess the process of neourethrisation in successful cases as well as pathogenesis of restricture in failure cases.

We analysed results of "U" shaped prostato-bulbar anastamosis in 132 patients with posterior urethral stricture, preoperatively and postoperatively with a retrograde urethrogram, urethrosonogram, uroflowmetry and patient satisfaction (based on symptoms). With comparative analysis, results were categorised as good, fair and poor. Twenty patients were randomly selected for urethroscopic evaluation to directly visualise the anastomotic site.

Good and fair results were counted as successful. On immediate postoperative evaluation the success rate was 96.2%, which remained almost the same at 6 months but decreased to 92.42% at 12 months and 90.9% at 24 months. Urethroscopy showed mucosal covering at the area of the roof of neourethra in patients having good results with patent and distensible lumen. Cases with fair results showed similar findings except for some narrowing at places and mucosal irregularities. Poor result cases mostly showed dense fibrosis with collapsed lumen or circumferential scarring leading to constricting stricture.

USPBA lacks disadvantages of ring anastamosis and is an effective option for posterior urethral strictures.