Uretroplastia término-terminal para el tratamiento primario de la estenosis de uretra: experiencia del Hospital General Dr. Manuel Gea González

Abstract

Background

Urethral stricture is a urologic disease that has significant morbidity. Direct visual internal urethrotomy is used for the majority of cases in the United States, but end-to-end urethroplasty is the most successful technique. The choice of primary management is controversial. Direct visual internal urethrotomy is widely accepted in the majority of Mexican hospital centers. However, it is reported to have lower long-term success rates. Urethroplasty is indicated for long, densely fibrotic strictures. Diagnosis is based on radiologic studies (nuclear magnetic resonance or ultrasound, with contrast medium). Scales (Urethral Stricture Score) describing stricture complexity are employed to choose surgical treatment.

Aims

To communicate the results of primary treatment for urethral stricture in patients at the Hospital General Dr. Manuel Gea González that underwent end-to-end urethroplasty.

Materials and Methods

A descriptive study was conducted that reviewed the case records of 210 patients with urethral stricture, selecting the 58 cases that underwent end-to-end urethroplasty as primary treatment within the time frame of January 1, 2007 and December 31, 2013.

Results

The median age of the patients was 46.4 years. Stricture etiology: traumatic 23%, iatrogenic 58%, idiopathic 17%, and infectious 2%. The most frequent stricture location was at the bulbar level (87.9%) (51), mean length was 2.12 cm, 3 cases presented with double-site stricture, 11% (19) of the cases had urinary retention, and the mean urethral stricture score was 5.8. There were 10 recurrences, 9 re-interventions (urinary tract infection), and one augmented urethroplasty. Preoperative Qmax was 5.7-10 ml/sec and postoperative Qmax was 13-16 ml/sec. Cure was achieved in 82.7% of the cases.

Conclusions

Urethroplasty success rates worldwide are reported at 84-97%. Results are related to stricture complexity and surgical experience. There is still no consensus on success parameters. Urethroplasty presents less recurrence compared with direct visual internal urethrotomy, promoting long-term quality of life.