We investigated the outcomes of three urethroplasty techniques in the surgical repair of strictures in the PF of 41 patients across two surgical centres. The techniques we investigated were Heineke-Mikulicz (HM) urethroplasty, substitution urethroplasty with ventral onlay buccal mucosal graft (BMG), and two-stage Johansen urethroplasty. Follow-up was typically conducted every 3 to 6 months, although there was no standardized regimen. We defined success of urethral stricture repair as a minimum of a 12-month follow-up period without the need for a repeat stricture intervention. Success rate was calculated based on the outcome of the first stricture intervention performed on each patient.
The success rate of HM urethroplasty was surprisingly low at 44% over 16 patients. Substitution urethroplasty with vental onlay BMG had a high success rate of 92% over 13 patients. Two-stage Johansen had a success rate of 75% over 12 patients, which is notable considering that this approach is used for complex or longer segment strictures (greater than or equal to 40mm).
In the setting of a failed HM urethroplasty in our cohort, a repeat HM urethroplasty had a 17% success rate, whereas a substitution urethroplasty following a failed HM urethroplasty had an 83% success rate. The low success rate of HM urethroplasty in our cohort may be related to the mobilization of the urethra distal and proximal to the vertical urethrotomy during horizontal closure, which may de-vascularize the adjacent urethra, or lead to remnant tension that compromises blood flow. Patching the urethral defect with resilient BMG in substitution urethroplasty requires minimal dissection, preserving the vascularity of the remaining urethral tissue after stricturotomy and scar excision. Our results may suggest that substitution urethroplasty may be a preferable option in the setting of failed HM urethroplasty. Two-stage Johansen urethroplasty remains useful for long or complex strictures not amenable to a single-stage repair.
In summary, urethroplasty for PF stricture repair had a highly variable success rate in our cohort, ranging from 44% to 92% depending on the type of urethroplasty. The optimal reparative procedure would depend on stricture length, severity, and local tissue mobility. Limitations of our study include a small sample size and heterogeneity in stricture characteristics between treatment groups. Future studies with a larger sample size could compare the success rates of different urethroplasty techniques for PF strictures with similar characteristics.
Written by: Hoyoung Jung,1,2 Mang L. Chen,3 Richard Wassersug,2 Smita Mukherjee,2 Sahil Kumar,2,4 Peter Mankowski,2,5 Krista Genoway,2,5 and Alex Kavanagh2,4
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
- Gender Surgery Program, Vancouver Coastal Health, Vancouver, British Columbia, Canada.
- G.U. Recon, San Francisco, California, USA.
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada