Paediatric Buccal Mucosal Graft Urethroplasty for Non-Hypospadias Urethral Strictures: A Single Centre Experience with Long Term Outcomes

Abstract

ObjectiveTo review our experience in the management of paediatric urethral strictures with buccal mucosal graft urethroplasty and its long term outcomes. MethodsThis was a retrospective analysis of a prospectively maintained data base between 2009–2019. Circumcised children with long segment urethral strictures (> 1.5 cm) were included. They were characterized as either peno-bulbar (PBS) or isolated bulbar strictures (IBS) based on a standardized protocol. All children underwent single stage dorsal onlay buccal mucosal graft urethroplasty by either the Kulkarni technique (PBS group) or the Barbagli technique (IBS group). All children were followed up at 3 months, then annually thereafter with flow rates at each visit. Success was defined as a flow rate > 10ml/sec with a bell-shaped curve and absence of need for any secondary procedures. Results28 children underwent buccal mucosal graft uretheroplasty.16 children were diagnosed with PBS & 12 children with IBS. The median age was 7.5 years (2–17 years) in PBS and 5.5 years (3–10 years) in IBS. Iatrogenic injury was the commonest aetiology ie 71 % (20/28). Mean length of stricture was 4 cm (3–5.5 cm) in PBS and 2.5 cm (2–3.5 cm) in IBS. Median follow up was 96 months (24-120 months) in PBS and 90 months (36-120 months) in IBS. The success rate was 87.5% (14/16) in PBS and 83.3% (10/12) in IBS. ConclusionSingle stage dorsal on lay buccal mucosal graft urethroplasty, ie Kulkarni and Barbagli techniques are safe and feasible in children with long segment urethral strictures with good long-term outcomes.