Outcomes of urethroplasty for anterior urethral strictures: A single-center experience

Purpose: The management of anterior urethral strictures is quite challenging due to high failure rates with many unavoidable postoperative complications. This study aims to elucidate the appropriate surgical techniques, advantages, and disadvantages of the different urethroplasties. Materials and Methods: We retrospectively recorded and analyzed twenty patients' demographics, surgical techniques, postoperative uroflowmetry, and complications. Patients were divided into two groups depending on the length of their strictures. Patients in Group 1 presented a urethral stricture or obliteration length of <3 cm and received excision and primary end-to-end anastomosed urethroplasty. Group 2 consisted of patients with a stricture or obliteration length of more than 3 cm who received buccal mucosa graft (BMG)-augmented dorsal onlay urethroplasty. The success rate and objective parameters following anastomosed or augmented urethroplasties were assessed over an 8-year follow-up period. Results: Despite the longer strictures and different number of complete obliterations, BMG-augmented urethroplasty exhibited comparable success rates (90%) with anastomosed urethroplasty (90%). The mean postoperative peak flow rates in the two groups were more than 15 mL/s, with Group 1 at 27.1 mL/s and Group 2 at 16.9 mL/s. No patients exhibited postoperative complications of incontinence or erectile dysfunction, no perineal wound infections were observed in any patient, and no significant complications were noted in the oral cavity where the buccal mucosa was harvested. Conclusion: Two conclusions were drawn from this clinical surgery experience. The first is that the type of urethral reconstruction should be considered according to the length of the urethral stricture. We suggest that urethral strictures longer than 3 cm are suitable for augmented urethral reconstruction. The second is that anatomical consideration of the urethra is also an important factor in choosing an appropriate urethroplasty. We recommend augmented urethral reconstruction for penile urethral strictures and anastomosed urethral reconstruction for bulbar urethral strictures.