1094 OUTCOME OF DORSAL ONLAY FOR LONG SEGMENT URETHRAL STRICTURE

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery III1 Apr 20101094 OUTCOME OF DORSAL ONLAY FOR LONG SEGMENT URETHRAL STRICTURE Patrick J. Bastian, Margit Mayer, Alexander Buchner, Stefan Tritschler, Christian G. Stief, and Christian Gozzi Patrick J. BastianPatrick J. Bastian More articles by this author , Margit MayerMargit Mayer More articles by this author , Alexander BuchnerAlexander Buchner More articles by this author , Stefan TritschlerStefan Tritschler More articles by this author , Christian G. StiefChristian G. Stief More articles by this author , and Christian GozziChristian Gozzi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2291AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of the study was to evaluate the interim outcome of long segment (> 2cm) urethral strictures managed by dorsal onlay/inlay following previous, endourological or open urethroplastic surgery. Reconstruction of the urethra included a perineal incision in lithotomy position and dissection of the musculus bulbospongiosus followed by complete scar excision and construction of a dorsal onlay next to the corpra cavernosa which represent a well vascularized recipient bed ensuring appropriate graft healing. METHODS Between August 2007 and April 2009 a total of 46 patients (mean age 57,2 years, 14 - 83 years) with complex urtethral strictures >2 cm were enrolled into the study. All patients underwent one stage urethral reconstruction using penile skin/foreskin in 42 cases and thigh (harvested by electrodermatom) in 4 cases, respectively. Etiology of strictures was either iatrogenic (n = 22), idiopatic (n=19), due to inflammation/balanitis xerotica (n = 3) or as a consequence of trauma (n =2). Outcome analysis included urinary flow, urethral calibration > 18ch, voiding cystometry and patient's satisfaction. RESULTS In fourty-four patients (95%) no recurrent urethral stenosis was observed resulting in a postoperative flow of average 31,7 ml/s (12-54) and an decrease of PVR from average 70,9 ml to 17,5 ml. Late complications (>30days) included stricture recurrence in 2 patients which were treated with glanduloplasty and dorsal onlay, respectively. One patient suffered from fistula which resolved spontaneously 5 weeks after operation. Cosmetic results were satisfactory in all patients. Postoperative voiding parameters were significantly improved (p<0.001). CONCLUSIONS One stage dorsal onlay/inlay for reconstruction of long segment urethral stenosis represents a reliable method with minimum complication rate even if the urethral plate is severely scarred or has been excised during previous surgery. Meticulous scar excision is necessary to provide a well vascularized grafting bed thus ensuring excellent graft imbibition. Munich, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e426 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick J. Bastian More articles by this author Margit Mayer More articles by this author Alexander Buchner More articles by this author Stefan Tritschler More articles by this author Christian G. Stief More articles by this author Christian Gozzi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...