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COMPARISON OF EVERTED END TO END ANASTOMOSIS AND PENILE PEDICLE SKIN GRAFT IN MANAGEMENT OF LONG STRICTURES: CROSS SECTIONAL STUDY

Dr. Mir Dost Muhammad Zadran, Tahira Gul, Dr. Nadir Hussain

Introduction: To treat patient with urethral stricture is a challenge for a surgeon. End to end anastomosis and graft of penile pedicle are two methods which are common for treatment of urethral stricture. This study was carried out to determine the outcome of everted end to end anastomosis compared with penile pedicle skin grafting so as to know which one is better of the two and should be offered to patients in future. Objective: To compare the outcome of Everted End to End Anastomosis and Penile Pedicle Skin Graft in management of long strictures to evaluate its post operative complications, hospital stay, and cost. Study was conducted on 70 patients, admitted with stricture urethra from the outpatient department of Urology and referred from emergency of Lahore General Hospital Lahore, Pakistan, starting from 13 October, 2011 to 31st october 2013. Material and method: A thorough history and clinical examination was done. All the patients had retrograde and antigrade urethrogram to make diagnosis with detailed history and Physical examination and routine baseline investigations. The patients were divided in two equal groups. 35 patients in group a received end to end anastomosis, and 35 patients in group B underwent penile pedicle skin grafting. The patients were evaluated for the outcome parameters including infection, re-stricture, urinary stream grading. The data was collected on a specially designed Proforma. Results: The mean age of the patients in group A was 20.60±12.61 years while in group B was 23.61±11.29 year [range 7 -50 years]. All the patients had urinary retention, while other symptoms were seen rarely. The majority of strictures were present at bulbo membranous level 57.1% in one group and 45.7% in other followed by bulbous level among i.e. 31.4% and 34.3% patients in both groups. In patients with end to end anastomosis, urinary stricture occurred in 22.9% patients while in penile pedicle skin graft was seen among 65.7% patients [p < 0.05]. None of the patient had infection. Uroflowmetery was 21.77 + 1.85 ml/sec in group A versus 17.00 + 7.04 mL/sec in group B at 1 year follow up [p < 0.05]. Conclusion: The outcome of everted end to end anastomosis is better than penile pedicle skin graft. So, this technique should be recommended in different settings. Keywords: Everted end to end anastomosis, penile pedicle skin graft; urethral stricture, urinary retention, bulbo membranous.

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