Buccal Mucosal Graft Research Articles

To Transect or Not Transect: Results from the Scandinavian Urethroplasty Study, A Multicentre Randomised Study of Bulbar Urethroplasty Comparing Excision and Primary Anastomosis Versus Buccal Mucosal Grafting

BackgroundOpen surgical treatment of short bulbar urethral strictures (urethroplasty) is commonly performed as transecting excision and primary anastomosis (tEPA) or buccal mucosa grafting (BMG). Erectile dysfunction and penile complications have been reported, but there is an absence of randomised trials. ObjectiveTo evaluate sexual dysfunction and penile complications after urethroplasty with tEPA versus BMG. Design, setting, and participantsCentres in Finland, Sweden and Norway participated. Patients with a bulbar urethral stricture of ≤2 cm without previous urethroplasty were randomised. The primary endpoints were the degree of erectile dysfunction and penile complications. Follow-up was 12 mo. InterventionPatients were randomised to either tEPA or BMG urethroplasty. Outcome measurements and statistical analysisSexual dysfunction was measured using the International Index of Erectile Function, 5-item version (IIEF-5) and a penile complications questionnaire (PCQ) designed for this study. Continuous data were analysed using analysis of covariance and categorical data were compared using a χ2 test. Results and limitationsA total of 151 patients were randomised to either tEPA (n = 75) or BMG (n = 76). The tEPA group reported more penile complications (p = 0.02), especially reduced glans filling (p = 0.03) and a shortened penis (p = 0.001). There were no differences in postoperative IIEF-5 total scores. Recurrence rates were similar in both groups (12.9%) but the study was not designed to detect differences in recurrence rates. The PCQ is not validated, which is a limitation. ConclusionsMore patients reported penile complications after urethroplasty with tEPA than with BMG. This should be considered when choosing the operative method, and patients should be informed accordingly. Patient summaryThis study compared two common operations for repair of narrowing of the male urethra. Neither of the two methods seems to cause worsened erections. However, penile problems are more common after the transection technique than after the grafting technique.

Sistema de puntuación uretral (U-score) simplificado para predecir la uretroplastia anterior compleja

ObjectiveTo assess U-score individual values as urethral complex surgery predictors. MethodsCross-sectional study including patients who received anterior urethroplasty from 2011 to 2019. U-score (etiology (1-2 points), number of strictures (1-2 points), anatomic location (1-2 points) and length (1-3 points)) was measured individually and globally. Surgical complexity was defined as low (anastomotic, buccal mucosal graft, and augmented anterior urethroplasty), and high complexity (double buccal mucosal graft, flap, and graft/flap combination). U-score components were included as complex surgery predictor and as main variable with individual probability values estimations and comparisons. Risk complex surgery probability groups were established. Results654 patients were included. Mean age was 57.2 years. Low complexity surgery was performed in 464 patients (259 anastomotic, 144 graft, 61 augmented anterior urethroplasty) and high complexity was done in 190 (53 double buccal mucosa graft, 27 flap, 110 graft/flap comb.). In multivariate analysis length, number of strictures and location were predictors of complexity. Introducing U-Score as only variable in univariate model predicted an OR 8.52 (95%CI 6.1-11). Simplified U-score grouping set obtained by complex probability was: low risk (4-5 points), medium risk (6 points) and high risk of complexity (7-9 points) Predicted risk of complex surgery probability (95%CI) for low, median and high risk group were 1.6 (0-2.9), 19.1 (13.8-25.9) and 77.9 (61.6-88.7), respectively. ConclusionsU-score can be used as a tool to predict complex urethral surgery. We present a simplified U-score risk tool to assess individual complex anterior urethroplasty probability.

Dorsal Onlay Buccal Mucosal Graft Urethroplasty for Long Segment Anterior Urethral Strictures: A Retrospective Study of Mid and Long-term Outcomes

Introduction: Dorsal onlay urethroplasty with Buccal Mucosal Graft (BMG) is the single stage procedure and is most commonly used to treat long segment anterior urethral strictures. Unilateral mobilisation of the urethra prevents both chordee and ischaemia. Aim: To evaluate the feasibility, medium-term and long-term outcomes of dorsal onlay BMGs when used to treat long anterior segment penile urethral stricture with unilateral mobilisation of the urethra. Materials and Methods: A retrospective study was conducted in Kasturba Hospital, Manipal, Karnataka, India, from January 2008-December 2018. A total of 56 patients with long anterior segment penile urethral strictures underwent BMG substitution for urethroplasty, with a follow-up period ranging from 1.2-10 years. The outcome of the procedure was assessed through clinical history and physical examination, uroflowmetry, retrograde and voiding cystourethrography and urethroscopy {6 French gauge (Fr)}. Statistical analysis was performed using the mean and median. Results: The mean age of 56 patients was 51.8±9.9 years, with a mean±Standard Deviation (SD) Maximum Flow Rate (MFR) of 20.1±5.3 mL at one month and 18.1±4.3 mL at three and 18.7±3.7 mL six months, 17.3±5.1 mL, 19.3±4.3 mL and 18.6±3.7 mL at one year, 2-5 years and 10 years postoperative respectively. Postvoid Residual urine (PVR) volume was higher till one year follow-up (i.e., 1st month it was 38.6±23.6 mL in 47 patients, 3rd month it was 45.8±22.4 mL in 12 patients, 6th month it was 49.0±28.8 mL in 14 patients and one year follow-up it was 43.9±30.8 mL in 24 patients). Minimal complications were noted over 5-10 years follow-up. Conclusion: For long segment anterior penile urethral strictures, unilateral mobilisation in BMG urethroplasty had shown success over both medium and long-term periods.

Clinical Study of Single Stage Dorsolateral Onlay Buccal Mucosal Graft Urethroplasty in Long Segment Anterior Urethral Stricture

1.1. Objectives: To evaluate the results of dorsolateral onlay buccal mucosal graft (BMG) urethroplasty in various types of long segment anterior urethral stricture. 1.2. Materials and Methods: This is a prospective study, conducted in the Department of Urology, Medical College, Kolkata and Burdwan Medical College, Burdwan from April 2017 to March 2021. Forty patients with long segment (more than 1.5 cm) anterior urethral stricture who underwent substitution urethroplasty using dorsolateral onlay BMG urethroplasty were evaluated with detailed history, physical examination, ultrasonography of KUB with PVRU, uroflowmetry, retrograde urethrography and voiding cystourethrography, sono-urethrograms and cystoscopy. After treatment with dorsolateral onlay BMG urethroplasty, they were followed-up with uroflowmetry at 3 monthly interval for one year and RGU and/or urethroscopy if indicated. Success was defined as normal voiding pattern without any intervention post-operatively. 1.3. Results: With nineteen of the forty cases (47.5%), lichen sclerosus formed the single most common etiology. Panurethral strictures were more common. Out of total 40 cases, 33 (82.5%) had successful outcome and 7 (17.5%) were failure. 1.4. Conclusion: We conclude that it is a simple, technically feasible, easily adoptable and finally successful procedure

Application of buccal mucosal graft to establish a new urination passage in male cats with penile traumatic injury.

Two male cats were presented with penile part of urethra injury due to dog attacks to the perineum and genitalia area. Chronic wound around a remained penile part of urethra due to the dog bite and perineal area was evident due to urine irritation. The buccal mucosa was harvested and subsequently placed on the granulation tissue of the wound to reconstruct the urinary passage. The buccal mucosal graft completely attached to the skin and urethra without any complications. From the follow-up at 3 months, the cats were able to urinate normally and the skin irritation from urine was resolved. In summary, the buccal mucosa is a good graft source and is suitable for the reconstruction of the urinary passage in severe and complicated cases of penile part of urethra injury in male cats.

Epispadias: recent techniques

Aim: This paper presents the latest surgical approaches for epispadias treatment in the pediatric population, as well as those for adolescent and adult populations after initial failed repair in childhood. Methods: The retrospective study was conducted between March 2005 and May 2020 and included 18 patients with the mean age of 21 months (range 11-48 months) (Group A), who underwent primary epispadias repair and 15 patients with the mean age of 18 years (range 13-29 years) (Group B), who underwent redo surgery after failed epispadias repair in childhood. In Group A, the surgery was performed as a one-stage procedure using complete penile disassembly technique, while, in Group B, the surgery was done as a two-stage procedure and included complete straightening and lengthening of the penis, followed by urethral reconstruction. Penile straightening and lengthening were achieved by tunica albuginea incision and grafting. In Group A, the urethral plate was mobilized, transposed ventrally, and tubularized and augmented with vascularized preputial skin flap where needed. In Group B, the urethra was reconstructed either using the buccal mucosa graft and genital skin flaps or with tubularization of genital skin flaps. Successful treatment was defined as a functional and esthetically acceptable penis without complications. Results: The mean follow-up was 88 months (range 15-197 months). Satisfactory results were achieved in 26/33 patients. Urethral fistula occurred in 4/18 patients from Group A and in 3/15 patients in Group B and was surgically repaired after four months. Skin dehiscence occurred in eight patients, five from Group A and three from Group B. Recurrent penile curvature was observed in 2/18 patients from Group A and required surgical correction and in 2/15 patients from Group B and was mild and did not need surgical repair. Eleven patients from Group B who filled out the International Index for Erectile Function reported satisfying erectile function, sexual desire, intercourse, and overall satisfaction. Conclusion: Primary or redo epispadias repair is challenging even for experienced reconstructive urologists. Only radical surgical approach can lead to complete correction of all deformities and provide successful outcome.

Buccal mucosal graft urethroplasty in male cats with traumatic complete urethral rupture.

To evaluate the feasibility of buccal mucosal graft urethroplasty for repairing complete urethral rupture in cats. 15 male domestic shorthair cats with traumatic complete urethral rupture. In each cat, a section of buccal mucosa was harvested, sutured, and formed into a tubule by use of an 8F indwelling catheter as support. This tubular graft was connected to both ruptured ends of the urethra to renew the urinary passage. The catheter was left in place until the absence of leakage was confirmed by positive contrast retrograde urethrography. After spontaneous urination was confirmed, cats were discharged from the hospital. Six months later, urethrography was repeated and owners were asked to score their cats' urinary function and quality of life. 13 cats recovered well following surgery, with no complications in the oral cavity or surgical site and no signs of difficulty or discomfort when urinating. Urethrography 2 weeks and 6 months after surgery revealed no stricture or leakage in the abdominal cavity. The 2 remaining cats developed a urethral stricture and underwent second surgery with a successful outcome. At the 6-month follow-up, 14 cats had only mild urinary signs, and 1 cat had incontinency. Owners indicated they were delighted (n = 14) or pleased (1) with their cats' quality of life. Buccal mucosa was found to be a good source of graft tissue for performance of urethroplasty in male cats, yielding satisfactory outcomes with few postoperative complications. The described technique may be suitable for severe and complicated cases of urethral rupture in male cats.

Outcome Analysis of Dorsal Buccal Mucosal Graft Urethroplasty in Perimenopausal Women with Urethral Stricture Disease

Purpose: To assess the clinical outcomes following dorsal buccal mucosal graft urethroplasty (BMGU) in perimenopausal women (PMW) suffering from urethral stricture disease. Materials and Methods: PMW (40–65 years) presenting with urinary symptoms were evaluated with uroflowmetry, voiding cystourethrogram (VCUG), and urethral calibration. PMW with maximum flow rate (Qmax) less than 10 ml/s or postvoid residual (PVR) volume greater than 50 ml, VCUG showing evidence of urethral stricture, and failure to calibrate with 14 Fr Foley catheter were included in the study. Patients with underactive bladder, carcinoma cervix, pelvic trauma, and oral submucosal fibrosis were excluded from the study. Patients satisfying inclusion and exclusion criteria underwent dorsal BMGU. Outcomes of the surgery were assessed by uroflowmetry at 3-monthly intervals. Results: The number of patients satisfying the inclusion and exclusion criteria between March 2014 and March 2020 was eight. The mean age of the patients was 52.1 years. The mean stricture length was 1.9 cm. The mean preoperative Qmax and PVR were 4.2 ml/s and 110 ml, respectively. The mean postoperative Qmax and PVR at 6 months were 15.4 ml/s and 39.1 ml, respectively. One patient had a recurrent stricture and underwent dilatation. Donor site complications were minor. The overall success rate of the procedure was 87%. Conclusion: Dorsal BMGU in females for urethral stricture disease offers successful urethral reconstruction and the advantage of least disruption of continence mechanism and resilience to hormonal changes in PMW.

Surgical Outcomes After Treatment of Urethral Complications Following Metoidioplasty in Transgender Men

BackgroundSeveral treatment options for urethral complications following metoidioplasty in transmen are described in the literature, yet little is known with regard to the surgical outcomes. AimThe aim of this study was to analyze the surgical outcomes after treatment of urethral strictures and urethral fistulas following metoidioplasty. MethodsA multicenter retrospective cohort study was conducted with transmen treated for strictures and fistulas after metoidioplasty in 3 tertiary referral centers. OutcomesThe primary outcome was the recurrence-free rate after surgical treatment of urethral strictures and urethral fistulas over a time period of 3 years postoperatively. ResultsOf 96 transmen included in this study with a urethral complication, 44 (46%) experienced a urethral fistula, 31 (32%) a urethral stricture, and 21 (22%) both complications simultaneously. The recurrence-free rate for urethral strictures following endoscopic management (ie, urethral dilation or direct visual internal urethrotomy) was 61% after 1, 50% after 2, and 43% after 3 years, compared to 82% following open treatment options after 1, 2, and 3 years (P = .002). Open treatment options were Heineke-Mikulicz procedure (7/9, 78% success), excision and primary anastomosis (3/3, 100%), 2-stage without graft (9/9, 100%), pedicled flap urethroplasty (1/1, 100%), and buccal mucosa graft urethroplasty (2/4 [50%] single-stage, 1/1 [100%] 2-stage). The recurrence-free rate for small urethral fistulas located at the pendulous urethra was 79% after 1, and 72% after 2 and 3 years, compared to 45% after 1, and 41% after 2 and 3 years for large fistulas, generally located at the urethral anastomoses of the fixed urethra. Treatment options for urethral fistulas were fistulectomy (26/48, 54%), fistulectomy & (redo) colpectomy (7/11, 64%), buccal mucosa graft urethroplasty (1/1, 100%), and retubularization of the urethral plate (3/4, 75%). A colpectomy before or during reoperation of a urethral fistula at the proximal urethral anastomosis showed higher success rates compared to without a colpectomy (7/11 [64%] vs 2/13 [15%] respectively, P = .03). Clinical ImplicationsThis study provides insight in the treatment possibilities and corresponding outcomes of urethral complications following metoidioplasty in transmen. Strengths & LimitationsStrengths were the relatively large sample size and the overview of multiple treatment options available. Limitations were the heterogeneity of the cohort, underexposure of some surgical modalities, and absence of patient-reported outcomes. ConclusionOpen surgical techniques show better long-term outcomes in the management of urethral strictures compared to endoscopic options, and a colpectomy is beneficial before or during urethral fistula repair at the proximal urethral anastomosis.de Rooij FPW, Falcone M, Waterschoot M, et al. Surgical Outcomes After Treatment of Urethral Complications Following Metoidioplasty in Transgender Men. J Sex Med 2022;19:377–384.

A buccal mucosal graft subcoronal resurfacing technique to treat recurrent penile adhesions: the buccal belt.

To outline our step-by-step surgical technique using a subcoronal buccal mucosal graft (BMG) resurfacing technique for the treatment of recurrent penile adhesions. To perform the 'buccal belt' procedure a subcoronal circumferential segment of diseased skin was excised. An appropriately sized BMG was circumferentially secured subcoronally with a proximal and distal anastomosis to the edges of the wound. Quilting stitches were also placed to allow proper graft fixation. A petroleum jelly bolster was secured as a tie-over dressing. Patients were discharged with a Foley catheter and the bolster dressing in place. The bolster and Foley catheter were removed 7 days postoperatively. The patients were then seen for follow-up at 4- to 6-month intervals. A retrospective, international multi-institutional review was conducted to include all patients who underwent this procedure. Surgical complications, evidence of recurrence, and patient-reported outcome measures including visual analogue scale (VAS) and global response assessment (GRA) questionnaires were reviewed. Thirty-one men underwent the procedure across six institutions between March 2014 and September 2020. The mean (range) surgical time was 59 (25-95) min. At the mean (range) follow-up of 27 (4-79) months all patients reported resolution of presenting symptoms and no recurrence of adhesions. The mean VAS score was 8.9 and 9.0 for aesthetics and functional outcomes, respectively. On GRA, overall improvement was reported by all patients (61%, +3; 25%, +2; 14%, +1). There are limited options for the treatment of recurrent penile adhesions. A subcoronal BMG resurfacing is feasible, with no recurrence and overall high satisfaction seen in an initial patient cohort.

Robot-assisted pyeloplasty with buccal mucosa graft for the management of an extended recurrent ureteropelvic junction stricture

A clinical case of robot-assisted pyeloplasty with buccal mucosa graft of an extended recurrent stricture of the left ureteropelvic junction is presented. The patient had previously undergone left-sided laparoscopic antevasal pyeloplasty and retrograde endopyelotomies with ureteral stenting. However, after these interventions, the dilatation of the left pelvicalyceal system persisted, the patient complained of lumbar pain and periodic exacerbations of chronic pyelonephritis. Transperitoneal robotic access isolated the ureteral upper third and the ureteropelvic junction from scar tissue, after dissecting the narrowed ureteral section, its length was about 3.0 cm. In this regard, plastic surgery was performed with a buccal mucosa graft, the ureter was drained with a stent. There were no postoperative complications, and on day 3 the patient was discharged. The stent was removed 4 weeks after. During the control ultrasound examination, the renal pelvicalyceal system was relatively reduced, and the patient did not notice any pain.

Management of complex ischial-urethral fistula in neurogenic patients performing clean intermittent self-catheterization.

Neurogenic patients performing clean-intermittent self-catheterization (CIC) may develop an urethral erosion, resulting in ischial-urethral fistulas (I-UF). In this work we present our single-center experience in dealing with this peculiar complication. In this work we included all neurogenic patients performing CIC treated at out Institution for I-UF. All patients had a spinal cord injury or myelomeningocele. We extracted from the patients' medical records the surgical management and postoperative clinical data. We defined failure the persistence of the fistula at X-ray contrast fistulography, retrograde urethrography, or uretrocystoscopy. We treated 11 patients (8 spinal cord injury, 3 myelomeningocele). Four patients have been treated with the placement of a new generation urethral stent (Uventa) after surgical toilette of the skin ulcer and placement of a temporary suprapubic catheter. All patients demonstrated a complete healing of the urethral lesion at stent removal and continued CIC without any difficulty. Four patients have been treated with perineal urethroplasty, requiring a buccal mucosal graft in two cases. In two patients a suprapubic permanent catheter was placed for a simpler bladder management due to the patients' comorbidities. In one case the incidental finding of an high grade muscle invasive urothelial bladder cancer, made it mandatory to perform an uretheroileocutaneostomy. This work represent a unique series of I-UF in neurogenic patients performing CIC. Surgical urethral reconstruction, often with the use of buccal mucosa in large lesions, may be a difficult solution in neurogenic patients, new generation stents (Uventa) represent a minimally invasive, effective, and safe alternative.

PROSPECTIVE COMPARATIVE STUDY ON OUTCOMES OF VENTRAL ONLAY BUCCAL MUCOSAL GRAFT URETHROPLASTY WITH OR WITHOUT FIBRIN GLUE.

Objectives: We described the use of brin glue in ventral onlay Buccal Mucosal Graft Urethroplasty (BMGU) in patients of bulbar urethral stricture and compared the outcome without brin glue. Methods: Sixty patients underwent bulbar urethroplasty with ventral onlay buccal mucosal graft and were included in this study. They were divided into 2 groups with 30 in each with group 1 with brin glue and group 2 without brin glue. The urethra was mobilized from the corpora cavernosa and opened along its ventral surface. The buccal mucosal graft was applied in the standard ventral onlay technique. Intraoperative evaluation included the lengths of surgery, stricture, and admission. Patients were followed up at 3 and 6 months in the outpatient department and primary outcome measures, that is, IPSS and Qmax were recorded at each follow-up along with complications if any. Results: No signicant difference was observed in mean lengths of surgery, stricture and admission, and distribution of pre-op IPSS and Qmax between the two groups. While a signicant difference was observed in distribution of IPSS and Qmax between the two groups at 3 months and 6 months follow-up. Distribution of early complications was observed at 3 weeks follow-up after surgery with a peri catheter RGU in both groups. 3 patients were presented with a leak in group 1 and 4 patients in group 2. At 3 months 2 patients were showing complications while at 6 months follow-up only 1 patient was showing complications in each group. Conclusions: The use of brin glue represents a slight but signicant step toward the perfection of the surgical technique of bulbar urethral reconstruction.

Tunica albuginea versus buccal mucosa graft urethroplasty for anterior urethral stricture: A prospective randomised pilot study

ObjectiveThe objective of the study was to compare the outcome of tunica albuginea urethroplasty (TAU) and buccal mucosa graft (BMG) urethroplasty for anterior urethral stricture. MethodsThirty patients who met the inclusion criteria were randomised into two groups: TAU (Group A) and BMG urethroplasty (Group B). Surgical outcome was evaluated with pre- and post-operative work-up involving retrograde urethrogram, voiding cystourethrogram, uroflowmetry, and urethroscopy. Patients were followed up till 1 year. ResultsMean duration of surgery was statistically significant between two groups (p=0.0005). Maximum urine flow rate was comparable when compared between two groups (p=0.22) but statistically significant when compared pre- and post-operatively (p<0.001). At follow-up of 1 year, the successful outcomes were 80% in Group A and 87% in Group B. A total of five patients who had unsuccessful results required redo urethroplasty. Complications were minimal in both the groups. ConclusionTAU provides outcomes equivalent to those of BMG urethroplasty. TAU has less operative time, easy to perform, and beneficial in patients with poor oral hygiene.

Buccal mucosal graft urethroplasty for anterior urethral stricture, experience from a low-income country

Background/purposeThis study was conducted to present our experience in urethral mucosal graft urethroplasty to repair urethral stricture, as the first experience in our context.MethodsThis is a prospective hospital-based study that had been designed to review management outcomes of buccal mucosal graft urethroplasty for anterior urethral stricture from January 2017 to January 2019.ResultsThe total number of involved patients was 60. The success rate was found to be 90% (n = 54), while 6 (10%) had a recurrence of stricture. Pain and pain combined bleeding from internal suture lines were the only early complication encountered in 50 (83.3%) and 2 (3.3%) patients, respectively. late complications occurred as follows 14 (23.3%) patients had UTI, 12 (20%) had wound infections, 8 (13.3%) had changes in ejaculation, and decrease in intensity of orgasm, and 6 (10%) had erectile dysfunction. One of the long-term complications was graft diverticulum in one case and was treated conservatively (in ventral on lay BMG).ConclusionImprovement of the service in limited resources countries like Sudan and was reflected in the excellent outcome of BMG urethroplasty as treatment of anterior urethral stricture (success rate 90%).

Substitution Buccal Mucosal Graft Urethroplasty for Long Segment Anterior Urethral Stricture : Our Experience in Dorsolateral Onlay Approach

Background: Currently the most favorable single stage procedure for management of long segment anterior urethral stricture is dorsal onlay technique of urethroplasty. This required circumferential extensive mobilization of the urethra, which might cause ischemia of urethra in addition to chordee. To evaluate the short term outcome of dorsolateral onlay BMG (Buccal Mucosal Graft) urethroplasty by unilateral urethral mobilization for treatment of long segment anterior urethral stricture&#x0D; Materials and methods: A prospective experimental study from January 2016 to December 2018 is carried out in Department of Urology, Chittagong Medical College Hospital (CMCH) Chattogram, Bangladesh. Total 32 patients of long segment anterior urethral stricture were treated by dorsolateral onlay BMG urethroplasty by unilateral urethral mobilization. Stricture &gt;2cm were included; RGU, MCU and Uroflowmetry were the mainstay of assessment. Success was defined as maximum flow rate &gt;15 ml/s, normal RGU and/ urethroscopy. Failure considered as presence of obstructive symptoms, Qmax &lt; 15 ml/s, stricture on RGU and any post-operative urethral intervention.&#x0D; Results: Mean stricture length was 48.72mm (Range: 30-77mm) and mean follow up time was 22.4months (Range: 12-40 months). Three patients were found to develop stricture at proximal anastomotic site during follow up and required optical internal urethrotomy and considered as failure. 01 patients developed Surgical Site Infection (SSI) which resolved after regular dressing. Success rate was 90.7%&#x0D; Conclusion: Dorsolateral onlay BMG urethroplasty by unilateral mobilization is feasible, safe and easily adoptable for long segment anterior urethral stricture with good short term outcome.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 14-17

Double-face urethroplasty in patients with obliterative bulbar strictures post-transurethral resection of the prostate mid-term outcomes in high-volume referral center

ObjectiveIncidences of post-transurethral resection of the prostate (post-TURP) strictures are between 2.2% and 9.8%. Stricture commonly occurs within the first 6 months. Our objective was to assess the outcomes of patients with obliterative strictures post-TURP that underwent a double-face urethroplasty. MethodsThis is a single-center prospective study of 17 patients with obliterative proximal bulbar stricture post-TURP who underwent double-face graft urethroplasty by two surgeons between January 2014 and January 2020. We defined post-TURP obliterative strictures as those patients who presented with complete or almost complete obstruction of the urethral lumen and who have had a history of acute urine retention. We have excluded patients with bladder neck contracture. Primary outcome was treatment success, defined as the no need for further treatments. Secondary outcome was post-urethroplasty continent rate. ResultsSeventeen patients were included in the study with median age of 66 (interquartile range 40–77) years; median time of follow-up was 24 (interquartile range 12–84) months; median stricture length was 4 (interquartile range 2–6) cm. Of the 17 patients, 15 (88.2%) were successful. All patients were continent after urethroplasty. ConclusionWith mid-term follow-up, treatment of obliterative proximal bulbar strictures with double-face buccal mucosa graft is a safe and effective procedure. Obliterative proximal bulbar strictures merit double-face urethroplasty with high-rate success and functional outcomes.

Validation of robotic-assisted ureteroplasty with buccal mucosa graft for stricture at the proximal and middle ureters: the first comparative study.

Although ureteroplasty with buccal mucosa graft for long-segmental ureteral stenosis has been developed long ago, evidence was still restricted to case series in published literature. This study aims to validate ureteroplasty with buccal mucosa graft (BMG) in long-segment stricture at the proximal and middle ureters under designed comparative methods. From April 2015 to January 2019, we performed robotic-assisted ureteroplasty with BMG with a two-phase design and compared ureteroplasty and BMG (phase 2 surgery) with endoscopic stenting (phase 1 surgery). Paired data of effective renal plasma flow (ERPF), glomerular filtration rate (GFR), hydronephrosis grade, and physical and psychological domains of the World Health Organization Quality of Life (WHOQOL)-BREF were compared. A total of 29 patients were enrolled, and only three (10%) patients had hydronephrosis resolution after treatment with endoscopic stenting (p = 0.250 to baseline). Compared to endoscopic ureteral stent, Hedges' g of ureteroplasty with BMG was 0.56 (95% CI 0.43-0.69), 0.63 (95% CI 0.46-0.80), 0.80 (95% CI 0.56-1.04), and 1.06 (95% CI 0.69-1.43) in EGFR, GFR, physical domain of WHOQOL-BREF, and psychological domain of WHOQOL-BREF, respectively (All significance; p < 0.001). After 12-month follow-ups, no recurrence of stricture was reported. In conclusion, Robotic-assisted ureteroplasty with BMG onlay is efficient in reconstruction of long-segment stricture of the proximal and middle ureters.

Robotic Ureteroplasty with Buccal Mucosa Graft: Technique for Complex Ureteral Strictures

Robotic Ureteroplasty with Buccal Mucosa Graft: Technique for Complex Ureteral Strictures

Yaşın üretroplasti sonucuna etkisi: eşleştirmeli analiz

Objective: The success of urethroplasty depends on a well-vascularized urethra, and in graft procedures, also on a healthy and well-vascularized graft bed for neovascularization. Elderly patients have an increased comorbid burden that may result in decreased penile and urethral blood flow. Therefore, we aimed to investigate whether age is an independent determinant of surgical success in patients undergoing urethroplasty. Material and Methods: The data of male patients who underwent urethroplasty (Excision-primary anastomosis and buccal mucosa graft) between 2015 and 2020 in our clinic were retrospectively analyzed. Urethroplasty success was defined as no urethral intervention required for at least one year of follow-up. Patients under the age of 60 were matched in a 1: 1 ratio with patients aged 60 and over, according to the length of the stricture and the type of operation. Patient characteristics were compared between the two age groups. Factors affecting success were evaluated with multivariate logistic regression analysis. Results: Nineteen patients (n= 8 excision-primary anastomosis, n= 11 buccal mucosa graft) aged 60 years and older were matched with those &lt;60 years of age. Mean age and follow-up period were 41.9±12.6 and 67.9±4.8 years (p= 0.001), 27.3±8.7 and 24.1±10.9 months (p= 0.325) for &lt;60 years and ≥60 years old groups, respectively. Presence of iatrogenic etiology (p= 0.026), comorbidity (p= 0.007) and coronary artery disease (p= 0.027) were more common in the group over 60 years of age. No significant difference was found between the groups in terms of diabetes mellitus, body mass index, smoking, history of previous urethral surgery, number of previous direct vision internal urethrotomy procedures, location of stricture, and success rates. Stricture length was the only significant clinical factor predicting success (p= 0.044). Conclusion: Urethroplasty success is affected by the length of the stricture, but not by age. Urethroplasty can be performed with similar success rates in elderly patients after evaluating the length of the stricture. Keywords: Urethral stricture, urethroplasty, age