7 MIDTERM OUTCOME OF COMBINED DORSAL PLUS VENTRAL DOUBLE BUCCAL MUCOSA GRAFT IN LONG ANTERIOR URETHRAL STRICTURE

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery1 Apr 20117 MIDTERM OUTCOME OF COMBINED DORSAL PLUS VENTRAL DOUBLE BUCCAL MUCOSA GRAFT IN LONG ANTERIOR URETHRAL STRICTURE Samir Elgamal, Mohamed Abo El-Enen, Mohamed Radwan, and Tarek Gamel Samir ElgamalSamir Elgamal Tanta, Egypt More articles by this author , Mohamed Abo El-EnenMohamed Abo El-Enen Tanta, Egypt More articles by this author , Mohamed RadwanMohamed Radwan Tanta, Egypt More articles by this author , and Tarek GamelTarek Gamel Tanta, Egypt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.068AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Buccal mucosal graft (BMG) substitution urethroplasty has become the most widespread method of anterior urethral stricture repair with good results.The aim of this study is to report the medium-term results of repairing long anterior urethral strictures with combined dorsal inlay plus ventral onlay buccal mucosal grafts. METHODS Between March 2007 and January 2009, 21 patients, mean age 37.3 years, with long anterior urethral strictures underwent combined dorsal inlay plus ventral onlay buccal mucosal graft urethroplasty. The strictured urethral segment was opened along its ventral surface; the exposed dorsal urethra was incised in the midline to create an elliptical area over the tunica albuginea where the dorsal inlay BMG was placed. Subsequently, the ventral onlay BMG was sutured to the urethral lateral margins to complete the urethroplasty. The follow-up included uroflowmetry with an ultrasound to estimate the residual urine volume at 3 months,6 months, 1 year and yearly thereafter, or at the onset of obstructive voiding symptoms. A retrograde urethrogram with a voiding cysto-urethrogram was taken at 3 and 6 months. A successful outcome was defined as normal voiding with no stricture on the voiding cysto-urethrogram and no need for subsequent instrumentation. RESULTS The mean (range) age of the patients was 37.3 (21–62) years. The mean preoperative maximum flow rate was 7.8 mL/s with a mean residual volume of 82.7 mL. . The mean operative duration was 124 min, and the stricture length 3.3 cm. The mean dorsal and ventral buccal mucosa graft length were, respectively, 2.8 and 5.3 cm. Follow-up was available in 19 patients (90.5%) with a mean of 23 months. The overall success rate was 89.5 %. Both failures occurred within the first year and were managed successfully by internal urethrotomy. There were no medium-term donor-site complications. Postmicturition dribbling of urine was noted in 4 patients (21%). CONCLUSIONS Combined double buccal mucosa graft is performed through ventral sagittal urethrotomy approach which is easier than the dorsal urethrotomy approach and has good results especially in patients with tight strictures with very narrow and scarred urethral plate as it provides wider neourethra than a single patch graft substitution. Our medium-term results are very encouraging. However, long-term results and more randomized studies are needed to establish this technique as a procedure of choice in future. © 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 Samir Elgamal Tanta, Egypt More articles by this author Mohamed Abo El-Enen Tanta, Egypt More articles by this author Mohamed Radwan Tanta, Egypt More articles by this author Tarek Gamel Tanta, Egypt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...