Objective: To evaluate the results of delayed urethroplasty after initial cystostomy following posterior urethral injury. Design: Descriptive study. Place And Duration of Study: Department of Urology and Transplantation, Jinnah Postgraduate Medical Center Karachi, over the span of two years (2001-2002). Subjects And Methods: Analysis of 15 patients undergoing delayed single stage perineal urethroplasty for posterior urethral distraction defect associated with pelvic fracture was performed. Preoperative evaluation of distraction defect included simultaneous retrograde urethrogram and voiding cystourethrogram. Postoperative pericatheter urethrogram was performed after three weeks and catheter removed in the absence of any leakage. Postoperative uroflowmetry and retrograde urethrogram was done after one month and three months respectively for average 12 months. Patients were evaluated specifically regarding stricture, impotence and incontinence postoperatively. Results: Mean age of the patients was 25 years. The estimated preoperative distraction defect was 3 cms. Mean follow up was six months, mean hospital stay was five days and duration of urethral stenting was average 3.6 weeks. Perineal urethroplasty was successful in 60% of cases. Ten patients underwent end to end anastomosis, seven (70%) proved to be successful while in S patients Badenoch pull-through urethroplasty was done. Successful results were obtained in 2 patients (40%). The criteria of success was no subsequent procedure required after urethroplasty. However, postoperative soft stricture, requiring optical urethrotomy less than twice, formed in 2 patients of end to end group and 2 patients of Badenoch pull through group. Rest of the patients from both groups, requiring salvage multiple endoscopic urethrotomies, were categorized as complete failure Conclusion: Overall success of our one stage perineal urethroplasty was 60%. The most probable factor responsible for failure in our opinion was incomplete removal of dense fibrosis from distraction defect.
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