[Analysis of success rates of uretroplasty for adult male bulbar urethral stricture: A systematic review]

Abstract

Male urethral stricture disease is prevalent and has an important impact on quality of life. Direct visual urethrotomy and dilatations have high rates of recurrence.

Objectives: The aim of this review of literature was to evaluate the success rates of different techniques of urethroplasty for strictures of the bulbar urethra.

Methods: We performed a systematic review of the MEDLINE literature from 2004 to 2015 following the PRISMA's statement recommendations. Key words were: urethroplasty, urethral reconstruction, onlay, graft, urethral stricture. Inclusion criteria were original articles describing the results of urethroplasty for bulbar urethral stricture in an adult male population. A minimum follow-up of 24 months was required.

Results: From 891 articles of the literature, 20 are studied in this review. Only 3 studies were prospective. The success rate of anastomotic urethroplasty varied from 68.7 to 98.8% for strictures from 1 to 3.5cm, from 60 to 96.9% for augmented urethroplasty performed for strictures from 4.2 to 4.7cm. Substitution urethroplasty with grafts presented from 75 to 89.8% of success for strictures from 2.6 and 4.36cm. Overall, 19/20 studies used buccal mucosal graft.

Conclusion: The success rate of urethroplasty for bulbar urethral stricture is high; the surgical technique should be adapted to the length of the stricture.

Keywords: Anastomotic urethroplasty; Excision-anastomose; Graft; Greffe; Onlay; Sténose urétrale; Urethral stricture; Urethroplasty; Urétroplastie.