Anastomotic urethroplasty in patients with infravesical obstruction

Selecting proper treatment for urethral strictures and obliterations of the urethra (as one of the causes for infravesical obstruction) is one of the actual questions in modern reconstructive urology. Anastomotic urethroplasty (using Marion-Holtsov technique) for correctly selected patients is one of the best ever techniques for surgical treatment of bulbar and membranous urethral strictures. In our centre we performed a prospective trial which included 24 patients, treated surgically from 2008 to 2010 years. The length of urethral gap was 1.5 - 7 cm (mean 3.5 cm). Treatment efficacy was controlled by means of retrograde urethrography, uroflowmetry and ultrasound investigation. The follow-up was 3-18 months (mean 12 months). At the last known follow-up the efficacy was 98%. Five patients with normal erectile function pre-operatively postoperatively showed some signs of erectile dysfunction though in all of these patients it spontaneously resolved, except one patient (4.1%) who was operated due to significant erectile dysfunction. Compared to endoscopic stricture treatment urethroplasty has some limitations (longer operation, rehabilitation and catheterisation time, lower accessibility in healthcare system and matched outcomes) but it is still actual in some situations. The final decision for treatment selection is the responsibility of the surgeon according to intraoperative findings. One important detail is that patients should be always informed on the possibility of substitution urethroplasty in case of extended urethral gap.