[Comparative anatomical study of three surgical approaches for treating complex posterior urethral stricture].

OBJECTIVE

To evaluate the advantages and disadvantages of 3 surgical approaches via superior intermedial margin of the pubis, inferior medial margin of the pubis, and the perineum, respectively, in the treatment of posterior urethral stricture.

METHODS

Thirty-five adult male corpses were dissected in which the distances from the bulbo-membranous urethra conjunction (D), the apex of prostate (E), and the bladder neck (F) to the superior medial margin of the pubis (A), the inferior medial margin of the pubis (B) and the midpoint of linear distance between the two ischial tuberosities on the perineum (C) were respectively measured and compared. Another 20 adult male corpses were subjected to the 3 surgical approaches as described above and the urethra was exposed to identify the tissues and organs with possible injuries resulted from the surgery, which were evaluated by scoring.

RESULTS

The distances measured were as follows: AD=6.5+/-0.5 cm, BD=2.2+/-0.5 cm, CD =3.4+/-0.6 cm, and BD<CD<AD (P=0.05, SNK means); AE=6.6+/-0.5 cm, BE=3.0+/-0.5 cm, CE=4.4+/-0.7 cm, and BE<CE<AE (P=0.05, SNK means); AF=5.7+/-0.6 cm, BF=4.5+/-0.5 cm, CF=6.5+/-0.6 cm, and BF<AF<CF (P=0.05, SNK means). The angles EAD (alpha1)=(9.3+/-2.0)(degrees), EBD (alpha(2))=(17.4+/-3.8)(degrees), ECD (alpha(3))=(9.2+/-1.6)(degrees), showing marked difference between alpha(1) and alpha(2) (P<0.05, t=11.1) and between alpha(3) and alpha(2) (P<0.05, t=12.1), but not between alpha(1) and alpha(3) (P>0.05, t=0.13). The angles FAE (beta(1)) =(22.7+/-2.6)(degrees), FBE (beta(2))=(32.9+/-6.4)(degrees), FCE (beta(3))=(15.0+/-3.2)(degrees), and beta(2) beta(1) beta(3) (P=0.05, SNK means). The score for tissue and organ injuries for the approach of the superior medial margin of the pubis was 13, 20 for the approach of inferior medial margin of the pubis, and 15 for perineum approach.

CONCLUSIONS

In terms of operative field exposure, the best operation approach is via the inferior pubis, followed by superior pubis approach and perineum approach; while in view of the injuries, superior pubis approach is better than the perineum and inferior pubis approaches. The inferior pubis approach should be the primary choice in the treatment of posterior urethral stricture.