Dorsal onlay urethroplasty using buccal mucosa graft versus penile skin flap for management of long anterior urethral strictures: a prospective randomized study

Abstract

Objective. The aim of this study was to compare the outcomes of dorsal onlay urethroplasty using buccal mucosa graft (BMG) versus penile skin flap (PSF) in the repair of long anterior urethral strictures. Material and methods. Patients with long anterior urethral strictures were randomized to receive either dorsal onlay BMG urethroplasty or PSF urethroplasty. All patients were evaluated preoperatively and during follow-up with the International Prostate Symptom Score (IPSS) and uroflowmetry. Success was reported when there were no obstructive symptoms on IPSS, with a peak urinary flow rate (Qmax) of at least 15 ml/s. Failure was reported in patients with obstructive symptoms, Qmax less than 15 ml/s and evidence of recurring stricture on urethrography. Results. The study included 19 and 18 patients in the BMG and PSF groups, respectively. The mean operative time was significantly shorter in the BMG than in the PSF group. The success rate was higher in the BMG than in the PSF group (89.5% vs 83.3%), but not statistically significant different. The PSF group included one case of extensive skin loss, three cases with superficial skin necrosis and two with minor penile torsion. In the BMG group, there were three cases of perioral numbness and another three had increased salivation. The incidence of troublesome postvoid urinary dribbling was significantly higher in the PSF than in the BMG group. After 6 months of urethroplasty, patient satisfaction was statistically significantly higher in the BMG than in the PSF group. Conclusions. BMG and PSF dorsal onlay urethroplasty had similar success rates. However, BMG is technically easier, takes less operative time and has a potential advantage in reducing postoperative morbidity, therefore leading to satisfaction for most patients.