Abstract
BackgroundLong anterior urethral stricture due to variable etiological factors constitutes a challenge for reconstruction.We evaluated our centers experience with cases of long anterior urethral stricture due to different etiologies that were managed by 2-stage substitution urethroplasty using buccal mucosal graft procedure.MethodsDuring the period between November 2009 and November 2016. All cases with long anterior urethral stricture that were planned for substitution urethroplasty in our department were enrolled in this study. The first stage was excision of most fibrotic areas of the urethral plate, the remaining of the urethra is laid open and augmented with buccal mucosal graft for second stage closure after 6–9 months.ResultsThe study included 123 patients who underwent first stage, 105 patients of them underwent second stage urethroplasty. Eighteen cases were missed after first stage. The mean (range) age was 38.4 (17–60 years). The mean (range) stricture length was 8.3 (4–13 cm). The cause of stricture was idiopathic in 47, inflammatory in 15, lichen sclerosus in 26 and post failed hypospadias repair in 35 patients. First stage was complicated by graft contracture in 11 (8.9%) patients that needed re-grafting, 5(4.1%) patient had bleeding from the buccal mucosa site that needed haemostatic sutures, oral numbness was reported in 7 (5.7%) patients. Second stage was complicated by wound dehiscence in 2(1.9%) patients, restricture in 11 (10.5%), fistula in 6 (5.7%) patients, meatal stenosis in 3 (2.9%). The overall success rate was 79.1% (83 cases out of 105) with a mean (range) follow-up of 34.7 (10–58 months).ConclusionsStaged urethroplasty using buccal mucosal graft procedure is an effective surgical option for patients with long anterior urethral strictures especially for patients with lichen sclerosus and those with failed previous surgical repair.
Highlights
Long anterior urethral stricture due to variable etiological factors constitutes a challenge for reconstruction
Urethral stricture is a process of progressing spongiofibrosis that leads to subsequent urethral narrowing and persistent lower urinary tract symptoms (LUTS) [1]
We report our experience of the feasibility of staged urethroplasty using buccal mucosal grafting to repair all long penile urethral strictures
Summary
Long anterior urethral stricture due to variable etiological factors constitutes a challenge for reconstruction. We evaluated our centers experience with cases of long anterior urethral stricture due to different etiologies that were managed by 2-stage substitution urethroplasty using buccal mucosal graft procedure. The management of long anterior urethral stricture remains an issue of controversy and continuing challenge, especially if it is lengthy or recurrent [2]. Single stage augmentation urethroplasty is recommended for most of penile urethral stricture. Penile skin flaps was the main modality of management of penile urethral strictures [7, 8]. Barbagli and colleagues reported the dorsal free graft urethroplasty initially using skin, but subsequently buccal mucosa, which was a modification of the Monseur
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