Internal urethrotomy as a complementary method after urethroplasties for posterior urethral stenosis

Area of Science:

• Urology
• Surgical Innovation
• Reconstructive Surgery

Background:

• Posterior urethral stenosis presents significant treatment challenges, with failure rates between 10-30%.
• Strictures resulting from pull-through or transpubic urethroplasty are particularly difficult to manage.
• Previous surgical interventions often lead to complex recurrent strictures.

Purpose of the Study:

• To evaluate the efficacy of internal urethrotomy as a complementary treatment for posterior urethral strictures.
• To assess outcomes in patients previously treated with pull-through or transpubic urethroplasty.
• To determine the success rate and complication profile of internal urethrotomy in this patient cohort.

Main Methods:

• A retrospective review of 105 patients (21 children, 84 adults) with posterior urethral strictures.
• Patients had undergone prior pull-through (69) or transpubic (36) urethroplasty.
• 18 patients with fair or poor outcomes underwent internal urethrotomy using the Sachse knife.

Main Results:

• Internal urethrotomy yielded good results in 80% of the transpubic group (8/10 patients).
• Good results were observed in 62.5% of the pull-through group (5/8 patients).
• No patients experienced postoperative incontinence or symptomatic urinary tract infections.

Conclusions:

• Internal urethrotomy is a viable and effective adjunctive therapy for managing complex posterior urethral strictures.
• The Sachse technique offers a favorable safety profile, avoiding incontinence and infection.
• This approach can improve outcomes for patients with recurrent or refractory urethral strictures.