PD3-01 MULTISTAGE BUCCAL MUCOSA GRAFT URETHROPLASTY FOR COMPLEX ANTERIOR URETHRAL STRICTURES

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery I1 Apr 2014PD3-01 MULTISTAGE BUCCAL MUCOSA GRAFT URETHROPLASTY FOR COMPLEX ANTERIOR URETHRAL STRICTURES Ryan Mori, Hadley Wood, and Kenneth Angermeier Ryan MoriRyan Mori More articles by this author , Hadley WoodHadley Wood More articles by this author , and Kenneth AngermeierKenneth Angermeier More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.146AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Anterior urethral strictures in the setting of previous hypospadius repair or lichen sclerosis (LS) present a challenge that often requires a multistage approach utilizing buccal mucosa graft (BMG). In order to assess outcomes following staged BMG urethroplasty, we reviewed our experience with this procedure. METHODS We retrospectively report our 12 year two-surgeon experience with staged BMG urethroplasty for long-segment, pan urethral, and multifocal urethral strictures. RESULTS 78 men with a mean age of 38.4 (8-66) underwent staged BMG urethroplasty from 2002-2013. The etiology was hypospadias (41, 52.6%), LS (31, 39.7%), a combination of both (3, 3.8%), trauma (4, 5.1%) or idiopathic recurrent stricture (4, 5.5%). Multifocal or panurethral stricture requiring simultaneous single stage repair of the bulbar urethra was present in 29 (37.2%). Disease was limited to the penile urethra in 49 (62.8%). Bilateral buccal grafts were required in 35 (44.9%) cases. To date 74 (94.9%) have been tubularized while 3 (3.8%) are pending second stage for various medical and socioeconomic reasons, 1 (1.3%) received his second stage elsewhere, and 1 (1.3%) opted to remain with a penoscrotal urethrotomy. Mean follow up was 11.9 months ( 0.75-104) and 50 (64.1%) had follow up of greater than 3 months. There were 14 complications in 12 (15.4%) patients with an overall complication rate of 17.9%. Eight (10.3%) patients required revision with 2 patients requiring multiple revisions. Details are as per Table 1. CONCLUSIONS Staged BMG urethroplasty is often necessary to successfully manage complex and long-segment anterior urethral strictures in the setting of LS or previous hypospadias repair. Our series demonstrates a very high rate of long term urethral patency and follow-through with urethral re-tubularization which is not evident in other series. Follow-up rates reflect the tertiary referral pattern. Complication and revision rates are low, and most frequently involve manageable distal urethrocutaneous fistula or glanular dehiscence. COMPLICATION N (%) Overall 14 (17.9) Post-op bleed 1 (1.3) UCF 5 (6.4) Glanular dehiscence 5 (6.4) Spraying stream 1 (1.3) Restricture 2 (2.6) SURGICAL REVISION Overall 10 (12.8) UCF 4 (5.1) Glanular dehiscence 3 (3.8) Spraying stream 1 (1.3) Restricture 2 (2.6) Multiple revisions 2 (2.6) © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e19-e20 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Ryan Mori More articles by this author Hadley Wood More articles by this author Kenneth Angermeier More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...