Pericatheter urethrogram after anastomotic urethroplasty: Is it a must?

Objective: To share our initial experience of patient undergoing anastomotic Urethroplasty and trial without catheter, without post Urethroplasty pericatheter urethrogram.

Methods: Prospectively maintained records of all patients undergoing standard transecting anastomotic Urethroplasty by single surgeon (one of the authors) at The Kidney Centre PGTI Karachi, Pakistan and Lifecare Hospital Abu Dhabi UAE from September 2006 to December 2017 were reviewed. In all except two cases, supra pubic catheter was removed at 2nd weeks and per urethral catheter by 4 to 5 weeks following which patients were assessed for TWOC without pericatheter urethrogram. Patients were further advised to follow up with Uroflowmetry (UFM) at one week, one month, three and 12 months. In our series, Qmax less than 15 ml/s on UFM were considered to have recurrence and these patients were subjected to ascending urethrogram after six weeks of procedure.

Results: There were 18 patients who underwent anastomotic Urethroplasty in bulbar urethra. The mean age of study patients was 37.2+11.2 years with p-value of 0.84. The recurrence rate of urethral stricture was 16.6 % (3/18 patient) with Qmax of 4.6 and 7.2ml/sec with mean follow-up period of 13.82+13.4 months (range 3-53 months) 02 patients developed infection. No patient developed incontinence or impotence.

Conclusion: We found pericatheter urethrogram is not mandatory as a routine for all tension free anastomotic Urethroplasty before per urethral catheter removal. However, it may have a role in difficult cases with tension anastomoses or re-do procedure. This will avoid risk of infection, radiation exposure and extra cost.