Comparison between the bulboprostatic gap and the index of elastic lengthening (Gapometry) in predicting surgical approach and surgical outcome in the repair of posterior urethral defects

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND| 2019. Objective: Urethral stricture longer than 2 cm usually requires urethroplasty. It can be performed by various approaches and different type of procedures. It can be achieved by a simple excision and primary anastomosis in a short bulbo-prostatic gap (usually <2.5 cm) or a more complex perineal or transpubic procedure when a long bulbo-prostatic gap is encountered. Few studies have addressed the pre-operative factor that help predicted the type of procedure performed. Materials and Methods: The authors retrospectively reviewed the medical records and radiographic imaging of 18 urethral stricture patients who underwent urethroplasty and compare the difference of bulbous urethra length and gap/bulbous urethra index between two groups; a group of patients who-underwent simple excision and primary anastomosis and a group of patients who underwent complex procedure which graft or additional procedure is required. Results: The mean urethral stricture length was not significantly different between two groups (1.40 cm vs. 1.97 cm; p = 0.221). We observed the difference of bulbous urethra length between two groups (6.95 cm vs. 5.50 cm; p = 0.029). However, the calculated gap/bulbous urethra index was not significantly different (0.20+0.13 vs. 0.37+0.21; p = 0.055). Conclusion: The surgical approach in bulbous and membranous urethral stricture can be predicted by the length of bulbous urethra. The short urethral gap does not always indicate the simple excision and primary anastomosis approach.