Failed anterior urethroplasty: Guidelines for reconstruction

Purpose: We analyzed the methods and outcomes of repeat urethroplasty in men with recurrent stricture after the failure of previous anterior urethroplasty. Materials and Methods: In 31 men with recurrent stricture after previous urethroplasty anterior urethral reconstruction was performed. Reconstructive methods varied according to stricture length and location. Results: End-to-end urethroplasty performed in 11 of 13 men with short (average 1.8 cm.) bulbar strictures was successful in all. Patch graft urethroplasty was successfully done in 4 men with intermediate (average 4.4 cm.) strictures. Penile circular fasciocutaneous flap urethroplasty performed in 13 of 14 men with long or distal strictures (average 8 cm.) was successful in 10 (79%). Overall excellent results were obtained in 28 of the 31 cases (90%). Conclusions: Guidelines for urethral reconstruction after failed anterior urethroplasty are predicated on stricture length, location and severity. Circular fasciocutaneous flap urethroplasty is extremely versatile and effective for refractory long or distal strictures. End-to-end urethroplasty with stricture excision is highly reliable for less extensive bulbar strictures for which previous operative repair has failed. Grafts are best used selectively in the reoperative setting.