6 RECONSTRUCTION OF COMPLEX OBLITERATIVE ANTERIOR URETHRAL STRICTURES VIA SINGLE STAGE OVERLAPPING DORSAL + VENTRAL DOUBLE ORAL MUCOSAL GRAFT TECHNIQUE

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery1 Apr 20116 RECONSTRUCTION OF COMPLEX OBLITERATIVE ANTERIOR URETHRAL STRICTURES VIA SINGLE STAGE OVERLAPPING DORSAL + VENTRAL DOUBLE ORAL MUCOSAL GRAFT TECHNIQUE Steven Hudak, Allen Morey, and Sanjay Kulkarni Steven HudakSteven Hudak Dallas, TX More articles by this author , Allen MoreyAllen Morey Dallas, TX More articles by this author , and Sanjay KulkarniSanjay Kulkarni Pune, India More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.067AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Augmentation urethroplasty in the context of a severely obliterated urethral plate is often performed via multi-stage reconstruction or via plate transection with focal resection. We present our initial experience with an alternative, single stage approach based on overlapping dorsal + ventral double oral mucosa grafts in men with severe anterior urethral strictures. METHODS A retrospective review of 696 urethroplasties performed at two tertiary urethroplasty centers from October 2007 to September 2010 was performed. Single stage urethral reconstruction utilizing urethral plate incision and/or excision and overlapping dorsal + ventral buccal mucosa grafts was utilized in 36 men (5%) with strictures found to be both complex and obliterative. Mean stricture length was 4.5 cm (range 1–16 cm). Dorsal grafts, applied to the most severely strictured segment, measured a mean 42% of the ventral graft length. Stricture location was bulbar (61%), penile (19%), or both bulbar and penile (20%). Failed prior treatment of urethral stricture disease was common (19%-urethroplasty, 61%-internal urethrotomy and/or dilation). RESULTS At a mean follow up of 13.9 months, 32 of the 36 cases were successful (89%). Repeat urethroplasty was performed in all 4 recurrences, 3 of which were successful at a mean follow up of 16 months. Five patients (14%) had early complications including transient urethrocutaneous fistula (1), superficial wound infection (2), and urinary tract infection (2). All resolved with conservative/medical therapy. CONCLUSIONS Single stage reconstruction of select patients with long, obliterative urethral strictures is safe, feasible, and effective using the overlapping dorsal + ventral double oral mucosal graft principle. The use of independently anchored overlapping grafts offers an alternative to multi-stage reconstruction, while avoiding primarily tubularized grafts. Graft Dimensions n Mean Graft Length (cm) Range (cm) Ventral Graft 36 5.4 3.5–12 Dorsal Graft 36 2.1 1–7 -w/ plate incision 10 2.0 1–4 -w/ plate excision 24 2.1 1–7 -w/ plate incision+excision 2 3.2 1–5.3 © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e3 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steven Hudak Dallas, TX More articles by this author Allen Morey Dallas, TX More articles by this author Sanjay Kulkarni Pune, India More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...