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

Objective To evaluate the advantages and disadvantages o f 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 disse cted in which the distances from the bulbo-membranous urethra conjuction (D), th e apex of prostate (E), and the bladder neck (F) to the superior medial margin o f the pubis (A), the inferior medial mar-gin of the pubis (B) and the midpoint o f linear distance between the two ischial tuberosities on the perineum (C) were respec-tively measured and compared. Another 20 adult male corpses were subjecte d to the 3 surgical approaches as described above and the urethra was exposed t o identify the tissues and organs with possible injuries resulted from the surge ry, which were e-valuated by scoring. Results The distances measured were as fol lows: AD=6.5±0.5 cm, BD=2.2±0.5 cm, CD =3.4±0.6 cm, and BDCDAD (P=0.05, SN K means); AE=6.6±0.5 cm, BE=3.0±0.5 cm, CE=4.4±0.7 cm, and BECEAE (P=0.05, SNK means); AF=5.7±0.6 cm, BF=4.5±0.5 cm, CF=6.5±0.6 cm, and BFAFCF (P=0.0 5, SNK means). The angles∠EAD (α 1 )=(9.3±2.0) o , ∠EBD (α 2 )=(17.4±3.8) o , ∠ECD (α 3 )=(9.2±1.6) o , showing marked difference between α 1 and α 2 (P0.05, t=11.1) and between α 3 and α 2 (P0.05, t=12.1), but not between α 1 and α 3 (P0.05, t=0.13). The angles ∠FAE (β 1 ) =(22.7±2.6) o , ∠FBE (β 2 )=(32.9±6.4) o , ∠FCE (β 3 )=(15.0±3.2) o , and β 2 β 1 β 3 (P=0.05, SNK means). The score for tissue and organ injuries for the appro ach of the superior medial margin of the pubis was 13, 20 for the approach of in ferior medial margin of the pubis, and 15 for perineum approach. Conclusions In terms of operative field exposure, the best operation approach is via the infer i-or pubis, followed by superior pubis approach and perineum approach; while in view of the injuries, superior pubis approach is better than the perineum and i nferior pubis approaches. The inferior pubis approach should be the primary choi ce in the treatment of posterior urethral stricture.