Graft procedure on urethroplasty, in comparison with flap procedure: a literature review

Abstract

Urethroplasty is a surgical procedure to reconstruct urethral patency on urethral stricture. There are several options for repairing urethral stricture in general, one of the examples is using graft or flap for augmentation urethroplasty. The indications of augmentation urethroplasty with graft are bulbar or penile urethral stricture, risk of tension on urethral anastomosis, and stricture more than 1 cm. Graft is less reliable because it has to be revascularized, easier to harvest, on the other hand flap has generous blood supply, but it was time-consuming to collect and to dissect. In case of bulbar urethral stricture with intact corpus spongiosum, graft had more advantages rather than flap because the anatomy of the urethra moves proximally giving thicker and more robust ventrally, and makes the graft suitable on vascular bed. Plenty of sites can be used to harvest graft for urethroplasty, there are buccal mucosa, genital skin, extragenital skin, lingual mucosa, bladder mucosa, and colonic mucosal graft. Although the treatment of urethroplasty depends on the length and location of stricture until today the comparison between the use of graft and flap in urethroplasty is still controversy and under debate.Some studies reported higher success rates in grafts than flaps procedure, but only few studies showed statistically significant difference. However, grafts procedure is easier, less operative time, and less morbidity, therefore leading to satisfaction in most of the patients.