Compare Outcomes Of Single Stage Vs Two Stage Urethroplasty For Panurethral Strictures Including Pre-Operative And Post-Operative Course
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Abstract
Aim: The aim of the present study was to compare outcomes of single stage vs two stage urethroplasty for panurethral strictures including pre-operative and post-operative course.
Methods: The Observational study was conducted at Dr. D.Y. Patil Medical College and Research Centre, Pimpri for the period of 2 years. The study was conducted in 40 patients randomly dividing into two groups, 20 patients underwent single stage urethroplasty and 20 underwent two staged urethroplasty with or without buccal mucosal graft urethroplasty based on size of urethral plate.
Results: In the present study, majority of the patients belonged to 41-50 years age group followed by 31-40 years age group and it was found that age groups were not statistically significant. Majority of the patients had Balanitis xerotica obliterans (LS) etiology followed by Post instrumentation/catheter and the results were not statistically significant. Majority of the patients had 13-15 cms length of stricture. In the present study, 12 and 16 were narrow external uretheral meatus in single and two stage respectively. In the two stage, Johanson’s urethroplasty procedure was done and in single stage, Kulkarni’s full length dorsal onlay BMG urethroplasty procedure was done. In single and two stage, Urethrocutaneous Fistula and Epididymo-orchitis complications were noted. In single stage, success was noted in 16 patients and in two stage, success was noted in 17 patients.
Conclusion: The single stage repair in patients with LS had good results with less re-stricture rates. The use of BMG as a substitution in single stage repair had re-stricture rates compared to flaps substitution. The two-stage repair should be limited to complex urethral strictures, failed urethroplasty and obliterated urethral stricture urethral caliber is less than 6F.
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References
Payne SR, Fowler S, Mundy AR. Analysis of a 7‐year national online audit of the management of open reconstructive urethral surgery in men. BJU international. 2020 Feb;125(2):304-13.
Kulkarni S, Joshi P, Surana S, Hamouda A. Management of panurethral strictures. African Journal of Urology. 2016 Mar 1;22(1):33-9.
Balanitis xerotica obliterans is the commonest cause of stricture we have encountered.
E. A. Eltahawy, R. Virasoro, S. M. Schlossberg, K. A. McCammon, and G. H. Jordan, “Long-term follow-up for excision and primary anastomosis for anterior urethral strictures,” Journal of Urology, vol. 177, no. 5, pp. 1803–1806, 2007.
Peterson AC, Webster GD. Management of urethral stricture disease: developing options for surgical intervention. Bju International. 2004 Nov;94(7):971-6.
Fenton AS, Morey AF, Aviles R, Garcia CR. Anterior urethral strictures: etiology and characteristics. Urology. 2005 Jun 1;65(6):1055-8.
Lumen N, Hoebeke P, Willemsen P, De Troyer B, Pieters R, Oosterlinck W. Etiology of urethral stricture disease in the 21st century. The Journal of urology. 2009 Sep 1;182(3):983-7.
Johanson B. Reconstruction of the male urethra in strictures. Acta Chir Scand Suppl 1953;176:1.
Santucci RA, Mario LA, Aninch JW. Anastomotic urethroplasty for bulbar urethral stricture: analysis of 168 patients. The Journal of urology. 2002 Apr;167(4):1715-9.
Barbagli G, Menghetti I, Azzaro F: A new urethroplasty for bulbar urethral strictures. Acta Urol Ital. 1995; 9: 313-7.
Barbagli G, Selli C, di Cello V, Mottola A: A one-stage dorsal free graft urethroplasty for bulbar urethral strictures. Br J Urol. 1996; 78: 929-32.
Heyns CF, Van der Merwe J, Basson J, Van der Merwe A. Etiology of male urethral strictures-Evaluation of temporal changes at a single center, and review of the literature. African Journal of Urology. 2012 Mar 1;18(1):4-9.
Ahmed A, Kalayi GD. Urethral stricture at Ahmadu Bello University Teaching Hospital, Zaria. East African medical journal. 1998 Oct 1;75(10):582-5.
Sharfi AR, Elarabi YE. The ‘watering‐can’perineum: presentation and management. British journal of urology. 1997 Dec;80(6):933-6.
Selim M, Salem S, Elsherif E, Badawy A, Elshazely M, Gawish M. Outcome of staged buccal mucosal graft for repair of long segment anterior urethral stricture. BMC urology. 2019 Dec;19:1-8.
Kulkarni SB, Joshi PM, Venkatesan K. Management of panurethral stricture disease in India. The Journal of urology. 2012 Sep 1;188(3):824-30.
Dubey D, Sehgal A, Srivastava A, Mandhani A, Kapoor R, Kumar A. Buccal mucosal urethroplasty for balanitis xerotica obliterans related urethral strictures: the outcome of 1 and 2-stage techniques. The Journal of urology. 2005 Feb;173(2):463-6.
McANINCH JW, Morey AF. Penile circular fasciocutaneous skin flap in 1-stage reconstruction of complex anterior urethral strictures. The Journal of urology. 1998 Apr;159(4):1209-13.
Hoy NY, Chapman DW, Rourke KF. Better defining the optimal management of penile urethral strictures: A retrospective comparison of single-stage vs. two-stage urethroplasty. Canadian Urological Association Journal. 2019 Dec;13(12):414.