Complex Posterior Urethral Stricture

Majority of posterior urethral stricture results from pelvic fracture, straddle injuries, or crush injuries. The management of traumatic posterior urethral strictures remains one of the most difficult tasks in urologic practice. In developed countries, agricultural activities have reduced over time and the number of accidents with pelvic fracture due to tractors tipping over has markedly decreased. Work site accidents have also markedly decreased due to the effective prevention of these kinds of accidents, and pedestrian, bicycle, and motorcycle accidents have diminished due to the increased using of cars. But patient conditions are so different from those present in developing countries, such as Egypt, India, Nepal, and China. In those countries, agricultural activities are still quite prevalent, the prevention of accidents on the work site has not dramatically lessened, and bicycles and motorcycles are the most popularly vehicles (1). Moreover, the emergency treatment of patients with PFUDDs in developing and developed countries is quite different. In Italy, emergency treatment for PFUDD was often provided by a urologist in 92.7% of cases, while in india emergency it is done by a general surgeon in 70.1% of cases. Since the majority of those patients have been treated using incorrect maneuvers in some developing country, iatrogenic damage to the urethra may be added (2). In our country, as China is large population, vast territory and uneven development of medical standards, many iatrogenic injurys were caused by inappropriate treatment, complex posterior strictures are not uncommon. Our center received nearly 200 complex posterior urethral strictures every year from all over the country. Hence, this chapter focuses on the management of traumatic posterior urethral injuries typically sustained in association with pelvic fracture. Complex posterior urethral strictures continue to represent a genuine challenge and they pose one of the most difficult management problems in urology, which represents 5% of all urethral strictures. It is characterized by a stricture gap exceeding 3cm, previous failed repair, associated perineal fistulas, rectourethral fistulas, periurethral cavities, false passages or an open bladder neck. Destruction or rupture of the posterior urethra is caused mainly by forces that occur during traumatic pelvic fracture. This trauma results in partial or complete rupture of the urethra. A complete rupture often results in destruction of the posterior urethra and may damage the sphincteric structures, while always damaging the neurovascular bundles, which results in impotence and incontinence. Due to prior repeated surgery, patients with complex strictures are often found significant scar tissue formation of the urethra. The problems arise from a lack of the healthy elastic tissue needed to reconstruct the urethra.