Dorsal Buccal Mucosal Graft Urethroplasty Research Articles

Outcomes of dorsal buccal mucosal graft urethroplasty in female urethral strictures

Outcomes of dorsal buccal mucosal graft urethroplasty in female urethral strictures

MP78-11 DORSAL BUCCAL MUCOSAL GRAFT URETHROPLASTY FOR VESICO-URETHRAL ANASTOMOTIC STENOSIS: LONG TERM FOLLOW UP

You have accessJournal of UrologyCME1 Apr 2023MP78-11 DORSAL BUCCAL MUCOSAL GRAFT URETHROPLASTY FOR VESICO-URETHRAL ANASTOMOTIC STENOSIS: LONG TERM FOLLOW UP Waleed Shabana, Vahid Mehrnoush, Hazem Elmansy, Ahmed Kotb, Ahmed S. Zakaria, and Walid Shahrour Waleed ShabanaWaleed Shabana More articles by this author , Vahid MehrnoushVahid Mehrnoush More articles by this author , Hazem ElmansyHazem Elmansy More articles by this author , Ahmed KotbAhmed Kotb More articles by this author , Ahmed S. ZakariaAhmed S. Zakaria More articles by this author , and Walid ShahrourWalid Shahrour More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess long term outcomes of dorsal buccal mucosal graft (BMG) urethroplasty for the repair of refractory vesico-urethral anastomotic stenosis (VUAS) post open radical prostatectomy. METHODS: We retrospectively reviewed collected data of patients underwent buccal mucosa graft urethroplasty following at least 3 interventions for VUAS. Patients were included if they completed 24 months after surgery. Patients’ demographics, preoperative continence status, number of dilations, and urine flow preoperatively and postoperatively were collected. Trial of void and retrograde urethrogram were done after 1-3 weeks. Patients were followed every 6 months up to 4 years by flowrate, postvoiding residual urine volume, cystourethroscopy and GRA questionnaire. RESULTS: Twelve patients underwent dorsal BMG urethroplasty between Jan 2018-Jan 2022. Eleven out 12 patients (91%) received adjuvant radiotherapy. Strictures were in the anastomotic site and median stricture length was 3 cm (2-4). All patients were incontinent preoperatively with median preoperative flow of 4.5 mL/s (2-7 mL/s). Mean operative time and blood loss were 182 minutes and 250 mL respectively. We did not record any case of intraoperative rectal injuries. No change in erectile function was noted. Median follow up was 24 months (range 9-48 months). The median flow at 24 months was 23 ml/sec. success rate at 24 months was 91% with one patient that failed immediately post operatively. Three out of 12 patients had artificial urinary sphincter post urethroplasty. GRA score of 4-5 was found in 100% of patients CONCLUSIONS: Dorsal BMG urethroplasty post VUAS has a solid promising urinary functional outcome. Dorsally placed BMG eliminate risk of rectal injuries associated with other approaches although incontinence persisted post repair. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1136 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Waleed Shabana More articles by this author Vahid Mehrnoush More articles by this author Hazem Elmansy More articles by this author Ahmed Kotb More articles by this author Ahmed S. Zakaria More articles by this author Walid Shahrour More articles by this author Expand All Advertisement PDF downloadLoading ...

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.

Outcome of dorsal buccal graft urethroplasty in female urethral stricture disease (FUSD); our institutional experience.

Female urethral stricture is a poorly studied disease entity. To date, its management has been poorly evaluated, with small numbers and various definitions of success. Treatment options traditionally have been urethral dilatation and/or self-catheterization with success rates ranging from only 14 to 49%. However, there has been increasing use of urethroplasty due to the improved success rate (70 to 100%). In this study we assessed the outcome of dorsal buccal mucosal grafts in female urethral stricture disease. In our study we prospectively analyzed 25 female patients treated from 2014 to 2019 at our institute; ages ranged from 26 to 66years. Dorsal buccal mucosal graft urethroplasty was performed in all patients. The pathology of female urethral stricture disease is unknown, and neither the pre- nor the intraoperative assessment allows determining the precise location and extent or the severity of urethral damage; therefore, we advocate extensive grafting of the entire urethra. Patients were followed every 3 months during the 1st year and then biannually with lower urinary tract symptom, uroflowmetry and post-void residual urine assessments. Stricture recurrence (failure) was defined as recurrence of symptoms, no change or reversal in Qmax and post-void residual urine values and failure of negotiation of a 17-Fr cystoscope. Success rate of our surgical intervention was > 90%. We observed that the mid-urethra was the most common location of the stricture. Stricture location was confined to the distal urethra in 12%, the mid-urethra in 16%, spanned the distal mid-urethra in 16%, spanned the mid-proximal urethra in 40% and spanned the pan-urethra in 16%. Mean stricture length was 1.8 (0.7-2.1)cm. Mean pre- versus postoperative Qmax was 5ml/s versus 23.3ml/s and mean residual urine was 178ml versus 18.5ml. Two patients had stricture recurrence at 3months post-intervention. Dorsal buccal mucosal graft currently represents a prime choice for female urethral stricture reconstruction, keeping in view the advantages of the procedure such as easy availability of the graft and fewer donor site comorbidities. We emphasize upfront urethroplasty and extensive urethral grafting.

108 The factors affecting the success and complications of the dorsal buccal mucosal graft urethroplasty in the treatment of anterior urethral stricture

108 The factors affecting the success and complications of the dorsal buccal mucosal graft urethroplasty in the treatment of anterior urethral stricture

Contemporary surgical management of female urethral stricture disease.

Female urethral stricture disease is increasingly recognized as an uncommon but important cause of lower urinary tract symptoms in women, which is amenable to surgical treatment. Several new reconstructive techniques have recently been described. The purpose of this review is to summarize the past literature with a focus on more recent contributions. Several new studies have recently been published investigating previously described reconstructive techniques including vaginal flap urethroplasty using the ventral approach, ventral labial graft, dorsal vaginal graft and dorsal buccal mucosal graft urethroplasty. Success rates, variably defined, ranged from 57.1 to 100% in these new contributions. No incidences of stress urinary incontinence were described. There continues to be lack of robust evidence to advocate one technique of urethroplasty for female urethral stricture disease over another, surgeon experience is likely to be an important factor. Urethroplasty using a flap or graft augmentation is a feasible treatment for female urethral strictures with good reported success rates and a minimal risk of stress of incontinence. Further studies are required to define the optimal technique and approach.

1695 MANAGEMENT OF URETHRAL STRICTURES IN WOMEN

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology1 Apr 20111695 MANAGEMENT OF URETHRAL STRICTURES IN WOMEN Jerry Blaivas, Rajveer Purohit, Janice Santos, Johnson Tsui, and Jeffrey Weiss Jerry BlaivasJerry Blaivas New York, NY More articles by this author , Rajveer PurohitRajveer Purohit New York, NY More articles by this author , Janice SantosJanice Santos New York, NY More articles by this author , Johnson TsuiJohnson Tsui Brooklyn, NY More articles by this author , and Jeffrey WeissJeffrey Weiss Brooklyn, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1886AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To describe the diagnosis and treatment of urethral strictures in women. METHODS This is a retrospective study of urethral strictures identified from a database of women seen between 1998-2010. Inclusion criteria included 1) a clinical diagnosis of urethral stricture, 2) stricture seen on cystoscopy, 3) urethral obstruction on videourodynamics (VUDS) according to the Blaivas-Groutz nomogram and/or 4) urethral calibration <17F. Pre- and postoperative symptoms, uroflow, and post-void residual urine were recorded for all patients; VUDS and cystoscopy were done preoperatively. Treatment was individualized. Post-operative recurrent stricture was defined by the same preoperative criteria. RESULTS 16 women with strictures, ranging in age from 32-98 years (mean = 60) were identified. The stricture was idiopathic in 8, iatrogenic in 6, and traumatic in 2. VUDS could not be done in 3 women due to complete obliteration of the urethra. 9/13 satisfied VUDS criteria for obstruction; 4 had impaired detrusor contractility. The site of obstruction was proximal urethra in 7, mid in 3, distal in 5 and panurethral in 1 patient. Eight women underwent vaginal flap urethroplasty (VFU); 5 of these had concomitant biologic pubovaginal sling (PVS) and one a Martius flap. There were no recurrences at a minimum of 5 years follow-up, but there were two recurrent strictures at 5½ and 6 years postop. One underwent dorsal buccal mucosal graft urethroplasty (BMG). The two recurrent strictures also underwent BMG and all were stricture free at 12–15 months post-op. 6/7 patients treated with urethral dilation recurred and required repeated dilations for the duration of their follow-up (.5–4 years; mean 2). CONCLUSIONS In selected patients, VFU and BMG have high success rates; 100% at 5 and 1 year respectively. Two strictures treated with VFU recurred at 5 & 6 years for an overall success rate of 88% suggesting long term follow-up is mandatory. Urethral dilation has a success rate of 14%. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e681-e682 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jerry Blaivas New York, NY More articles by this author Rajveer Purohit New York, NY More articles by this author Janice Santos New York, NY More articles by this author Johnson Tsui Brooklyn, NY More articles by this author Jeffrey Weiss Brooklyn, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Tunica albuginea urethroplasty for panurethral strictures.

To assess the efficacy of tunica albuginea urethroplasty for pan urethral stricture management as an alternative approach to conventional dorsal buccal mucosal graft urethroplasty, especially in cases with unavailability of healthy buccal mucosa. Eighty-six patients with panurethral strictures underwent tunica albuginea urethroplasty at our center with follow-ups at 6, 12, 24, and 36 months. Results were assessed by comparative analysis of preoperative and postoperative patient's satisfaction (based on symptoms) along with retrograde urethrography, urethrosonography, and uroflowmetry. Ten patients from the successful group underwent postoperative urethroscopic examination. Counting good and fair results as successful (satisfied and not requiring revision urethroplasty), success (good + fair) rate was 95.3% at immediate postoperative and at 6 months. Results reduced to 93% at 12 months, 90.7% at 24 months, and 89.5% at the end of 36 month follow-up. Failure (poor results requiring revision urethroplasty) rate was 10.5% at the end of the 3 years of follow-up. Tunica albuginea urethroplasty runs over the concept of urethral groove and the ease of procedure with adequately satisfactory results provides decent outcomes. Tunica albuginea urethroplasty gives advantage of local availability and achieving patent distensible urethra without any graft. Urethroscopy of these subjects, by direct visualization shows the area of roof formed by tunica appears well covered with urothelium, further substantiating its ability to maintain patency and distensibility of the urethra.

Outcome of dorsal buccal graft urethroplasty for recurrent bulbar urethral strictures

To audit our results of dorsal buccal mucosal graft urethroplasty for recurrent bulbar urethral stricture disease and compare them with those from specialist centres. Data were collected prospectively on 52 men who had urethroplasty with > or =1 year of follow-up; failure was defined as the need for further intervention. The mean (range) age of the patients was 39 (19-61) years and 23 (45%) had an identifiable cause for their stricture. The mean (range) stricture length was 3.5 (1.5-6) cm and was associated with moderate or severe spongiofibrosis in 38 (73%) men. Ten (19%) men had minor complications after surgery. The mean (range) follow-up was 34 (12-80) months, with the mean maximum urinary flow rate increasing from 6 to 24 mL/s after surgery. The surgery failed, requiring dilatation or urethrotomy, in seven (14%) men at a mean (range) of 25 (15-50) months after urethroplasty, giving an overall success rate of 86%. This prospective audit of dorsal buccal patch augmentation urethroplasty for bulbar strictures shows an equivalent outcome to the standard set by the expert originators, suggesting that is transferable to less specialized centres. The efficacy, low complication rate, short hospital stay and general applicability of the technique encourage its use for all men with recurrent bulbar stricture disease, but formal comparison with other options in randomized trials, including cost-effectiveness analysis, is needed.

Dorsal Buccal Mucosal Graft Urethroplasty for Anterior Urethral Stricture by Asopa Technique

BackgroundBuccal mucosal graft (BMG) substitution urethroplasty has become popular in the management of intractable anterior urethral strictures with good results. Excellent long-term results have been reported by both dorsal and ventral onlay techniques. Asopa reported a successful technique for dorsal placement of BMG in long anterior urethral strictures through a ventral sagittal approach. ObjectiveTo evaluate prospectively the results and advantages of dorsal BMG urethroplasty for recurrent anterior urethral strictures by a ventral sagittal urethrotomy approach (Asopa technique). Design, setting, and participantsFrom December 2002 to December 2007, a total of 58 men underwent dorsal BMG urethroplasty by a ventral sagittal urethrotomy approach for recurrent urethral strictures. Forty-five of these patients with a follow-up period of 12–60 mo were prospectively evaluated, and the results were analysed. InterventionThe urethra was split twice at the site of the stricture both ventrally and dorsally without mobilising it from its bed, and the buccal mucosal graft was secured in the dorsal urethral defect. The urethra was then retubularised in one stage. Results and limitationsThe overall results were good (87%), with a mean follow-up period of 42 mo. Seven patients developed minor wound infection, and five patients developed fistulae. There were six recurrences (6:45, 13%) during the follow-up period of 12–60 mo. Two patients with a panurethral stricture and four with bulbar or penobulbar strictures developed recurrences and were managed by optical urethrotomy and self-dilatation. The medium-term results were as good as those reported with the dorsal urethrotomy approach.Long-term results from this and other series are awaited. More randomised trials and meta-analyses are needed to establish this technique as a procedure of choice in future. ConclusionsThe ventral sagittal urethrotomy approach is easier to perform than the dorsal urethrotomy approach, has good results, and is especially useful in long anterior urethral strictures.

Long-Term Efficacy of Distal Penile Circular Fasciocutaneous Flaps for Single Stage Reconstruction of Complex Anterior Urethral Stricture Disease

We determined the overall efficacy and predictors of success of the distal penile circular fasciocutaneous flap in the management of complex anterior urethral stricture disease not due to lichen sclerosus. We performed a retrospective review of all patients undergoing reconstruction of complex anterior urethral strictures without lichen sclerosus repaired from 1985 to 2006. Primary and overall stricture-free survival curves were estimated using the Kaplan-Meier method. Cox proportional hazards regression analysis was used to identify univariate and multivariate predictors of flap success. A total of 124 patients met the inclusion and exclusion criteria. Median patient age was 48 years (range 16 to 83). Median followup was 7.3 years (range 1 month to 19.5 years). Median stricture length was 8.2 cm (range 0.5 to 24). At 1, 3, 5 and 10 years the overall estimated stricture-free survival rates were 95%, 89%, 84% and 79%, respectively. On multivariate analysis smoking (HR 4.0, 95% CI 1.2-12.9, p = 0.02), history of hypospadias repair (HR 4.4, 95% CI 1.3-14.6, p = 0.01) and stricture length 7 to 10 cm (HR 7.0, 95% CI 1.4-34.7, p = 0.02) were predictive of failure. Fasciocutaneous flap urethroplasty has good and durable success rates in the treatment of complex anterior urethral strictures. Predictors of failure included smoking, history of hypospadias repair and longer stricture length.

Dorsal Buccal Mucosal Graft Urethroplasty by a Ventral Sagittal Urethrotomy and Minimal-Access Perineal Approach for Anterior Urethral Stricture

OBJECTIVE To present the technique of dorsal buccal mucosal graft urethroplasty through a ventral sagittal urethrotomy and minimal access perineal approach for anterior urethral stricture. PATIENTS AND METHODS From July 2001 to December 2002, 12 patients with a long anterior urethral stricture had the anterior urethra reconstructed, using a one-stage urethroplasty with a dorsal onlay buccal mucosal graft through a ventral sagittal urethrotomy. The urethra was approached via a small perineal incision irrespective of the site and length of the stricture. The penis was everted through the perineal wound. No urethral dissection was used on laterally or dorsally, so as not to jeopardize the blood supply. RESULTS The mean (range) length of the stricture was 5 (3-16) cm and the follow-up 12 (10-16) months. The results were good in 11 of the 12 patients. One patient developed a stricture at the proximal anastomotic site and required optical internal urethrotomy. CONCLUSION Dorsal buccal mucosal graft urethroplasty via a minimal access perineal approach is a simple technique with a good surgical outcome; it does not require urethral dissection and mobilization and hence preserves the blood supply.

Dorsal buccal mucosal graft urethroplasty by a ventral sagittal urethrotomy and minimal-access perineal approach for anterior urethral stricture.

To present the technique of dorsal buccal mucosal graft urethroplasty through a ventral sagittal urethrotomy and minimal access perineal approach for anterior urethral stricture. From July 2001 to December 2002, 12 patients with a long anterior urethral stricture had the anterior urethra reconstructed, using a one-stage urethroplasty with a dorsal onlay buccal mucosal graft through a ventral sagittal urethrotomy. The urethra was approached via a small perineal incision irrespective of the site and length of the stricture. The penis was everted through the perineal wound. No urethral dissection was used on laterally or dorsally, so as not to jeopardize the blood supply. The mean (range) length of the stricture was 5 (3-16) cm and the follow-up 12 (10-16) months. The results were good in 11 of the 12 patients. One patient developed a stricture at the proximal anastomotic site and required optical internal urethrotomy. Dorsal buccal mucosal graft urethroplasty via a minimal access perineal approach is a simple technique with a good surgical outcome; it does not require urethral dissection and mobilization and hence preserves the blood supply.