Repair of the difficult posterior urethral stricture
Fewer than 10% of strictures which follow pelvic fracture will be complex, the vast majority being amenable to simple perineal anastomotic repair. The complex strictures are best managed in a center experienced in their care and a variety of maneuvers are used for their correction. One-stage anastomotic repairs are still optimal and are applicable to most cases, however, the surgeon must be prepared to elaborate the procedure depending on the intraoperative findings. Substitution urethroplasties (one- or two-stage vascularized flaps) are reserved for salvage in cases in which associated anterior urethral pathology or long urethral defects preclude an anastomotic procedure. Erectile dysfunction and incontinence which may accompany more severe injuries are now manageable by prosthetic and other techniques. © 1987 Springer-Verlag.
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