V12-13 TWO-SIDED DORSAL PLUS VENTRAL ORAL GRAFT URETHROPLASTY FOR LONG ANTERIOR URETHRAL STRICTURES

Abstract

You have accessJournal of UrologyReconstruction1 Apr 2016V12-13 TWO-SIDED DORSAL PLUS VENTRAL ORAL GRAFT URETHROPLASTY FOR LONG ANTERIOR URETHRAL STRICTURES Fikret Fatih Onol, Sinasi Yavuz Onol, Ahmet Bindayi, Ahmet Tahra, Eyup Veli Kücük, and Ugur Boylu Fikret Fatih OnolFikret Fatih Onol More articles by this author , Sinasi Yavuz OnolSinasi Yavuz Onol More articles by this author , Ahmet BindayiAhmet Bindayi More articles by this author , Ahmet TahraAhmet Tahra More articles by this author , Eyup Veli KücükEyup Veli Kücük More articles by this author , and Ugur BoyluUgur Boylu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2139AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Substitution urethroplasty provides good functional results in bulbar and penile urethral strictures. However, treatment of long (extending from external meatus to bulbar urethra) and tight strictures remains a challenge. One-sided (dorsal or ventral) substitution urethroplasty may not be sufficient in long strictures with a narrow urethral plate. In recent years, we have opted to use two-sided oral mucosa graft (OMG) in such cases. We describe our technique of two-sided OMG urethroplasty in long and tight strictures. METHODS Among the 83 men that underwent anterior urethroplasty in our clinic between 2010 and 2015, 23 (27.7%) had long (>80mm) or multiple strictures. Clinical evaluation included assessment of subjective symptoms with the AUA symptom score and patient-reported outcome measure for urethral stricture (USS-PROM), uroflowmetry, and combined retrograde urethrography/voiding cystourethrography. We performed two-sided urethral augmentation in patients with a tight stricture (ie. urethral caliber <5 Fr). Under lithotomy position, the entire anterior urethra was exposed through penile invagination from the midline perineal incision. OMG was first placed as ′dorsal inlay′: urethra was split along the stricture both ventrally and dorsally without mobilizing it from its bed, and the graft was secured in the dorsal urethral defect. A ′ventral onlay′ OMG was then augmented to the narrowest segment of the stricture. Foley catheter was removed after 2 to 3 weeks. Patients were followed postoperatively at 1st, 3rd, and 6th months, and annually thereafter. Cure was defined as a normal-appearing flow curve at the last postoperative visit and absence of any restenosis requiring additional intervention. RESULTS Two-sided OMG technique was used in 7 patients. Mean stricture length was 137.9±40.4 mm (range: 80 to 190 mm). With a median follow-up of 32 months (range: 6 to 58), 85.7% were cured. One patient developed recurrent stricture and underwent internal urethrotomy. Mean AUA symptom score decreased from 19.8±10.2 preoperatively to 3.2±1.6 postoperatively (p=0.02). Similarly, baseline USS-PROM LUTS score decreased from 10±4.6 to 1.5±1.4 postoperatively. Mean maximum flow rate (ml/sec) increased from 4.2±1.6 preoperatively to 28.2±10.8 postoperatively (p=0.03). CONCLUSIONS Two-sided dorsal plus ventral oral graft urethroplasty appears as an effective technique for long anterior urethral strictures. The two-sided OMG may facilitate the reconstruction of a wide-caliber urethral lumen in tight strictures. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1070 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Fikret Fatih Onol More articles by this author Sinasi Yavuz Onol More articles by this author Ahmet Bindayi More articles by this author Ahmet Tahra More articles by this author Eyup Veli Kücük More articles by this author Ugur Boylu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...