Reconstruction of urethral erosion in men with a neurogenic bladder.

Objective: To describe the surgical outcomes and operative technique for reconstructing catheter-induced urethral erosion in men with a neurogenic bladder.
Patients and Methods: This was a prospective study of 11 men (median age 45 years, range 26-52) who had elective urethroplasty for urethral erosion between 2004 and 2007 by one surgeon (C.M.G.). All men had a diagnosis of neurogenic bladder and indwelling catheter-induced urethral erosion. Reconstructive techniques included primary closure in six men, substitution urethroplasty with a penile skin graft in three, penile skin flap in one and a buccal mucosa graft in one. A two-stage approach was used in one man.
Results: The median (range) length of erosion from the meatus before surgery was 6 (4-10) cm. The repair was successful in seven men at a mean (range) follow-up of 25 (8-46) months. Of those with recurrence of erosion, the median length of the resultant defect was 2 (2-3) cm. All recurrences were in the first five patients of this series. The median time to recurrence of erosion was 1 month and recurrence did not appear to be related to any particular surgical technique. Urethral catheter traction after surgery appeared to be one of the factors related to repair breakdown.
Conclusion: The reconstruction of catheter-induced urethral erosion in men with a neurogenic bladder is feasible. Primary closure appears to be the best reconstructive method for urethral erosion, and avoiding catheter traction after surgery contributes to successful urethroplasty.