Urethroplasty management in 100 cases of urethral stricture: a rationale for procedure selection

We performed 100 urethroplasties for urethral strictures that fulfilled our criteria for surgical intervention. Strictures were located in the pendulous urethra in 14 cases, bulbar urethra in 33 and membranous urethra in 32, while the entire urethra or multiple adjacent areas were strictured in 21. The etiology of the strictures was traumatic in 47 patients and inflammatory in 22, and no cause was identified in 31. One-stage repairs were performed in 76 cases. Anastomotic repairs were optimal for short traumatic strictures, with 1 failure among 29 cases. Full thickness skin graft repairs were performed for more lengthy inflammatory strictures in 34 cases, with 5 failures. Mitigating against success in these patients were extrapenile skin donor sites, tubed grafts and poor graft beds. Vascularized island flap repairs were performed in 13 patients with 1 failure but there was an associated problem of redundant repairs. Two-stage repairs were reserved primarily for long or multiple strictures, with 2 failures in 24 cases. We conclude that procedure selection should be determined by stricture characteristics, including location, etiology, length and the presence of local adverse factors. An over-all rate free of stricture of 91 per cent was achieved.