What is the follow-up care after end to end primary anastomosis of the urethra?

Follow-Up Protocol After End-to-End Primary Anastomosis of Urethra

The optimal follow-up after end-to-end primary anastomosis of the urethra should include urethroscopy or urethrogram at 2-3 weeks post-surgery to assess healing, followed by regular monitoring for at least one year to detect potential stricture recurrence. 1

Immediate Post-Operative Care

• A urinary catheter should remain in place following urethral reconstruction to divert urine from the surgical site and prevent urinary extravasation 1
• Either urethral catheter or suprapubic cystostomy is acceptable, though a urethral catheter is generally preferred 1
• Antibiotic prophylaxis should be continued according to pre-operative urine culture results to prevent infection at the surgical site 1

Early Follow-Up (2-3 Weeks)

• Retrograde urethrogram (RUG) or voiding cystourethrogram (VCUG) should be performed 2-3 weeks following open urethral reconstruction to assess for complete urethral healing 1
• If the anastomosis appears well-healed without extravasation, the urinary catheter can be removed 1
• If leakage is detected, catheter drainage should be maintained for an additional period 1

Intermediate Follow-Up (3-6 Months)

• Clinical evaluation should include assessment of urinary symptoms, particularly decreased urinary stream, incomplete emptying, or dysuria 1
• Uroflowmetry with measurement of peak flow rate (success typically defined as >15 ml/second) and post-void residual volume assessment are recommended 1
• Flexible cystoscopy may be performed to directly visualize the anastomosis and confirm absence of recurrent stricture 1

Long-Term Follow-Up

• Regular follow-up should continue for at least one year, as most recurrences occur within the first year (median time to recurrence is 3 months) 2
• The success rate of end-to-end anastomosis for urethral strictures is high (90-98.8%) when performed in appropriate cases 3, 4
• Patients should be monitored for potential complications including:
  • Recurrent stricture (occurs in approximately 1-40% of cases) 2, 4
  • Sexual dysfunction (reported in 2.3-6% of cases) 2, 4
  • Urinary tract infections 2, 5

Monitoring for Recurrence

• Patients should be instructed to report any symptoms of decreased urinary stream, incomplete emptying, dysuria, or urinary tract infections promptly 1
• For suspected recurrence, diagnostic evaluation should include uroflowmetry, post-void residual measurement, and urethroscopy or urethrogram 1
• Most recurrences occur within the first year after surgery, with the majority presenting within the first 3-6 months 2, 5

Return to Activities

• Return to sports activities should be allowed only after microscopic hematuria has resolved 1
• Patients should be counseled to avoid strenuous activities that could place stress on the anastomosis during the healing period 4

Special Considerations

• In cases of posterior urethral injuries, particularly those associated with pelvic fractures, more intensive follow-up may be required 1
• For patients with additional risk factors for recurrence (previous failed repairs, longer strictures, or history of radiation), more frequent follow-up evaluations may be warranted 5

The long-term success of end-to-end anastomosis is excellent when performed for appropriate indications (short strictures with healthy surrounding tissue), with studies reporting durable results in 93-98.8% of cases with proper follow-up and management 5, 4.