Long-term efficacy of oral mucosa urethroplasty (report of 324 cases)

Abstract

Objective To summarize the long-term efficacy of oral mucosal urethroplasty. Methods The clinical data of 324 patients with anterior urethral stricture who underwent oral mucosal urethroplasty from January 2013 to May 2018 were retrospectively analyzed. The patients were 27-65 years old with an average age of 47 years. Among them, 51 patients had urethral meatal stenosis, 174 patients had penile urethral stricture and 99 patients had bulbar urethral stricture. The length of urethral stricture was 2.8-14.0 cm, with an average of 6.4 cm. The preoperative maximal urinary flow rate Qmax was 3.2-8.4 ml/s, with an average of 4.8 ml/s. In the urethral meatal stenosis group (51 patients), 15 underwent urethrotomy and 36 underwent meatal urethroplasty. In the penile urethral stricture group (174 patients ), ventral sagittal incision was done in 21 patients, subcoronal circumferential incision in 49 patients and midline perineal incision in 104 patients. The perineal incision or verted Y incision were done in all the bulbar urethral strictures. Results The patients were followed-up for 3-75 months, with an average of 35.0 months. The results were satisfied in 290(89.5%)patients. The post-operative maximal urinary flow rate Qmax was 15.8-32.2ml/s, with an average of 21.5 ml/s. Thirty-four patients (10.5%)developed recurrent urethral stricture, including 7 patients in the urethral meatus, 17 patients in the penile urethra and 12 patients in the bulbar urethra. Among the recurrent urethral stricture patients, 18 treated with the dilatation and 16 treated with the urethroplasty. Five patients (1.5%)developed fistula, including 2 patients in the ventral sagittal incision, 1 patient in the circumferential incision and 2 patient in the perineal incision. Conclusions The long-term effect of oral mucosal urethroplasty is realistic. The rate of urethral stricture recurrence and fistula is low. The recurrence can be treated again by urethroplasty. The surgical approach for oral mucosa urethroplasty depends on the location and length of the anterior urethral stricture. Key words: Urethral stricture; Oral mucosa; Urethroplasty; Surgical approach; Long-term efficacy