Dorsal Onlay Buccal Mucosal Graft Research Articles

Short Term Outcome of Dorsal Onlay Buccal Mucosa Graft for the Management of Bulbar Urethral Stricture

Objective: To assess the success of buccal mucosal graft (BMG) urethroplasty by the dorsal onlay technique in long anterior urethral stricture (> 2 cm long). Method: This prospective interventional study was conducted in the Department of Urology, National Institute of Kidney Diseases and Urology, Sher-e-Bangla Nagar, Dhaka from January 2016 to December 2017 over a period of two years. Thirty three patients with primary and recurrent stricture of anterior urethra involving the bulbar urethra scheduled for single buccal mucosa graft urethroplasty were included in this study. Written consent was taken from each patient. Patients with stricture at posterior urethra or at distal penile urethra or stricture length <2 cm or above 6 cm were excluded from this study. Urethral malignancy cases were also excluded. All the patients were treated with dorsal onlay BMG urethroplasty. Results: Maximum patients were more than 40 years old. Mean age was 44.42 ± 7.43 years. Maximum patients had stricture more than 3 cm long. Mean length of stricture was 3.14 ± 0.65 cm. Cause of stricture was inflammatory (42.4%), idiopathic (27.3%), traumatic (21.2%) and iatrogenic (9.1%). Regarding clinical presentation, Poor urinary stream was found in 30 (90.9%) patients, urethral discharge in 12 (36.4%) patients, LUTS in 25 (75.8) patients and acute urinary retention in 9 (27.3) patients. Baseline peak urinary flow rate was 9.59 ± 1.68 ml/s. Peak urinary flow rate after 3 months of operation was 16.50 ± 2.19 ml/s and after 6 months of operation was 18.33 ± 4.40 ml/s. Post operative voided urine volume after 3 months of operation was 253.21 ± 41.22 ml and after 6 months of operation was 301.21 ± 50.38 ml. UTI was 3 (9.09) after 3 months and 5 (15.15) after 6 months of operation. Recurrence of stricture was 3 (9.09) after 3 months and 4 (12.12) after 6 months of operation. Urethra was seen narrow in 4 (12.12%) cases after 3 months and 6 (18.18%) cases after 6 months of operation. Regarding complications, Bleeding was in 4 (12.12%) cases, dribbling of urine in 5 (15.15%) cases, wound infection in 2 (6.06%) cases and 3 (9.09%) cases. Conclusion: Dorsal onlay BMG urethroplasty seems as an effective method for the management of long anterior urethral strictures. Bangladesh Journal of Urology, Vol. 22, No. 1, January 2019 p.15-19

A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis

To critically evaluate a multi-institutional patient cohort undergoing Dorsal-Onlay Buccal Mucosal Graft Urethroplasty (D-BMGU) for recurrent post-radiation posterior urethral stenosis. Retrospective multi-institutional review of patients with posterior urethral stenosis from 10 institutions between 2010-2019 was performed. Patients with at least 1-year follow-up were assessed. Patient demographics, stenosis characteristics, peri-operative outcomes, and post-operative clinical and patient-reported outcomes were analyzed. The primary outcomes were stenosis recurrence and de-novo stress urinary incontinence (SUI). Secondary outcomes were changes in voiding, sexual function, and patient-reported satisfaction. Seventy-nine men with post-radiation urethral stenosis treated with D-BMGU met inclusion criteria. Median age and stenosis length were 72years, (IQR 66-75), and 3.0cm (IQR 2.5-4cm), respectively. Radiation modalities included: 36 (45.6%) external beam radiotherapy (EBRT), 13 (16.5%) brachytherapy (BT), 10 (12.7%) combination EBRT/BT, and 20 (25.3%) EBRT/radical prostatectomy. At a median follow-up of 21months (IQR 13-40), 14 patients (17.7%) had stenosis recurrence. Among 37 preoperatively-continent patients, 3 men (8.1%) developed de-novo SUI following dorsal onlay urethroplasty. Of 29 patients with preoperative SUI all but one remained incontinent post-operatively (96.6%). Following repair, patients experienced significant improvement in PVR (92.5 to 26cc, p = 0.001) and Uroflow (4.6 to 15.9cc/s, p = 0.001), and high overall satisfaction, with 91.9% reporting a GRA of + 2 or better). Dorsal onlay buccal mucosa graft urethroplasty is a safe and feasible technique in patients with post-radiation posterior urethral stenosis. This non-transecting approach may confer low rates of de-novo SUI. Further research is needed to compare this technique with excisional urethroplasty.

Development and content validation of the Urethroplasty Training and Assessment Tool (UTAT) for dorsal onlay buccal mucosa graft urethroplasty.

To develop and validate the Urethroplasty Training and Assessment Tool (UTAT) using Healthcare Failure Mode and Effect Analysis (HFMEA) for training and assessment of urology trainees learning this urethral reconstruction technique, as urethroplasty is the 'gold standard' treatment for long and recurrent urethral strictures and with a variety of techniques and a lack of standardised reconstructive curricula, there is a need for procedure-specific training tools to improve surgeon training and patient safety. This international observational study was performed over an 11-month period. The HFMEA was used to identify and evaluate hazardous stages of urethroplasty to develop the UTAT. Hazard scores were calculated for the included steps of urethroplasty. Content validation was performed by 12 expert surgeons and multidisciplinary teams from international tertiary centres. The HFMEA process resulted in an internationally validated UTAT. Hazard scores ≥4 and single point weaknesses were included to implement actions and outcome measures. Content validation was achieved by circulating the process map, hazard analysis table, and developed tools. Changes were implemented based on the feedback received from expert surgeons. The content validated dorsal onlay buccal mucosa graft bulbar UTAT contained five phases, 10 processes and 23 sub-processes. The modular UTAT offers a comprehensive validated training tool developed via a detailed HFMEA protocol. This may be utilised to standardise the training and assessment of urology trainees.

MP35-13 COMPARISON OF TWO TECHNIQUES OF DORSAL ONLAY URETHROPLASTY

INTRODUCTION AND OBJECTIVE:Various technique has been described for the treatment of short non-traumatic bulbar stricture. Of these technique, dorsal onlay buccal mucosa graft (BMG) urethroplasty e...

MP35-18 DORSAL ONLAY URETHROPLASTY FOR RADIATION-INDUCED URETHRAL STENOSIS; A MULTI-INSTITUTIONAL RETROSPECTIVE REVIEW

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (MP35)1 Apr 2020MP35-18 DORSAL ONLAY URETHROPLASTY FOR RADIATION-INDUCED URETHRAL STENOSIS; A MULTI-INSTITUTIONAL RETROSPECTIVE REVIEW Michael Hughes*, Connor Policastro, Francisco Martins, Jay Simhan, Nicolaas Lumen, Krishnan Venkatesan, Javier Angulo, Shubham Gupta, Paul Rusilko, Erick Alejandro Ramírez Pérez, Alan Quach, Michael Altwell, Kirk Redger, Brian Flynn, Stephen Blakely, and Dmitriy Nikolavsky Michael Hughes*Michael Hughes* More articles by this author , Connor PolicastroConnor Policastro More articles by this author , Francisco MartinsFrancisco Martins More articles by this author , Jay SimhanJay Simhan More articles by this author , Nicolaas LumenNicolaas Lumen More articles by this author , Krishnan VenkatesanKrishnan Venkatesan More articles by this author , Javier AnguloJavier Angulo More articles by this author , Shubham GuptaShubham Gupta More articles by this author , Paul RusilkoPaul Rusilko More articles by this author , Erick Alejandro Ramírez PérezErick Alejandro Ramírez Pérez More articles by this author , Alan QuachAlan Quach More articles by this author , Michael AltwellMichael Altwell More articles by this author , Kirk RedgerKirk Redger More articles by this author , Brian FlynnBrian Flynn More articles by this author , Stephen BlakelyStephen Blakely More articles by this author , and Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000879.018AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of recurrent post-radiation urethral stenosis is notoriously difficult due to poorer success rates and the risk of de-novo stress urinary incontinence (SUI) following reconstruction. Although many prior reports describe outcomes of anastomotic or ventral buccal mucosa graft (BMG) augmentation techniques, dorsal onlay BMG urethroplasty (D-BMGU) has not been sufficiently assessed. Here we report patency and continence outcomes following dorsal onlay BMG urethroplasty in a large multi-institutional cohort undergoing treatment of post-radiation urethral stenosis. METHODS: Men with a history of radiotherapy for prostate cancer treatment who underwent D-BMGU for posterior urethral stenosis from 10 institutions between 2010-2019 were reviewed. Patients with a minimum of 8 months follow up were included. Preoperative patient characteristics and continence status were reviewed. Postoperative outcomes including urethroplasty failure, SUI, uroflow, post-void residual volume and PROM questionnaires were analyzed. RESULTS: Of 86 men with post-radiation stenosis treated with D-BMGU, 67 (78%, mean age 69, (range 52-85)) met inclusion criteria with a mean length of stenosis 3.9 cm (1.5-18). Radiation modalities included: 30 (45%) external beam radiotherapy (EBRT), 10 (15%) brachytherapy (BT), 9 (13%) combination EBRT and BT; and 18 EBRT and radical prostatectomy (27%). At a mean follow up of 27 months (8-88), 13 patients (19%) had urethral stenosis recurrence. Of 31 patients who had no SUI prior to surgery, only 2 men (6.4%) developed de-novo SUI following dorsal onlay urethroplasty. All 27 patients (27/67, 40%) with SUI prior to surgery remained incontinent post operatively. Of the remaining 9/67 (13.4%) men whose baseline continence status was unknown, 4/9 (44%) were incontinent post operatively. CONCLUSIONS: With comparable success rates to previously reported techniques, dorsal onlay urethroplasty with BMG is a feasible management option in patients with post-radiation posterior urethral stenosis. This non-transecting approach demonstrates diminished rates of de-novo stress incontinence compared to historically reported rates with excisional urethroplasty. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e519-e520 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Hughes* More articles by this author Connor Policastro More articles by this author Francisco Martins More articles by this author Jay Simhan More articles by this author Nicolaas Lumen More articles by this author Krishnan Venkatesan More articles by this author Javier Angulo More articles by this author Shubham Gupta More articles by this author Paul Rusilko More articles by this author Erick Alejandro Ramírez Pérez More articles by this author Alan Quach More articles by this author Michael Altwell More articles by this author Kirk Redger More articles by this author Brian Flynn More articles by this author Stephen Blakely More articles by this author Dmitriy Nikolavsky More articles by this author Expand All Advertisement PDF downloadLoading ...

Dorsal onlay buccal mucosal graft or penile skin graft substitution urethroplasty in bulbar urethral stricture: compare the outcome and review

Background: Authors describe their experience with dorsal onlay urethroplasty using Buccal mucosal graft or penile skin graft through dorsal sagittal urethrotomy for bulbar urethral stricture.Methods: From 2014 to 2017, 29 male patients with bulbar urethral stricture have been treated by one stage dorsal onlay substitution urethroplasty using buccal mucosal graft and penile skin graft. Patients with balanitis xerotica obliterans, unhealthy penile skin, oral mucosa pathology or those who had undergone more than one urethral dilation/internal urethrotomy or urethroplasty were excluded from study. Results were analyzed at 6th and 12th month follow up with clinical history and uroflowmetry. Clinical outcome was considered a failure when any postoperative instrumentation was needed, including dilation or optical internal urethrotomy.Results: A total of 16 men age between 21 to 56 years for buccal mucosa graft (BMG) urethroplasty and 13 men age between 18 to 59 years underwent dorsal onlay substitution urethroplasty using BMG and penile skin graft (PSG). Mean stricture length was 4.2 cm (3.8-6) for BMG urethroplasty and 4.1 cm (3.2-5) for PSG urethroplasty. Mean length and width of graft were 4.2 cm and 2.6 cm respectively in BMG urethroplasty while 4.6 cm and 2.5 cm in PSAG urethroplasty. Average follow up months were 13.4 months with overall success rate 87.5% in BMG urethroplasty while average follow up months were 14.6 months with overall success rate 82.3% in PSG urethroplasty.Conclusions: On short term follow up substitution urethroplasty using both penile skin and buccal mucosa graft have comparable results.

Dorsal onlay versus dorsal inlay buccal mucosal graft urethroplasty for anterior urethral stricture: a single centre retrospective study

Background: Urethral stricture is a relatively common disease. The choice of surgery is based on the stricture location, length of the stricture and etiology. Buccal mucosal graft (BMG) urethroplasty with Asopa and Kulkarni techniques, revolutionized the approach to anterior urethral stricture repair. Objective of the study was to compare both the dorsal onlay BMG urethroplasty technique of Kulkarni and the dorsal inlay BMG urethroplasty technique of Asopa for the management of long anterior urethral stricture. Methods: From January 2015 to October 2019, a total of 90 patients with long anterior urethral strictures were randomized into two groups. Group A (42 patients) managed by Kulkarni technique. Group B (48 patients) managed by Asopa technique. BMG urethroplasty was considered successful if no further procedure required postoperatively with maximum flow rate >15 ml/s during the follow-up period.Results: The success rate in group A and B were 80.9% and 87.5%, respectively. The mean operative time was significantly longer in group A (175±22.6 min) than in group B (102±18.14 min, p-value <0.001). The average blood loss was significantly higher in group A (154±15.65 ml) than in group B (112.76±12.62 ml, p-value <0.012).Conclusions: The dorsal onlay technique of Kulkarni and the dorsal inlay technique of Asopa buccal mucosal graft urethroplasty are reliable and satisfactory procedures with good success rates and minimum complications.

Dorsal onlay buccal mucosa graft urethroplasty for bulbar urethral stricture: a single centre experience.

Introductionthe successful treatment for urethral strictures demands not just attention to surgical details but careful selection of the reconstructive technique. For long segment urethral strictures substitution urethroplasty is required. This study sought to determine the success rate and complications of dorsal onlay buccal mucosal graft (BMG) urethroplasty for long segment urethral strictures in our hospital.Methodsthis was a retrospective study carried out at Jos University Teaching Hospital from March 2015 to March 2018. The case notes of male patients who had dorsal onlay buccal mucosal graft urethroplasty for long segment bulbar urethral stricture within the study period were retrieved. Patients´ demographics, cause and nature of urethral strictures, duration of follow up, the success rate and complications were collected and subjected to statistical analysis using SPSS® version 22.Resultstwenty-four men with mean age of 45 years (range 14-67 years) had dorsal onlay buccal mucosal graft urethroplasty during the study period. The mean stricture length was 4.5cm (range, 2-7cm). After a mean follow up duration of 2 years (range, 1 4 years), 21(87.5%) patients had a successful urethroplasty as they were able to pass urine at one year post urethroplasty without lower urinary tract symptoms, while 3(12.5%) had recurrence of the urethral stricture. At the recipient site, 2(8.3%) patients had primary bleeding that did not require blood transfusion. Also, 2(8.3%) patients had superficial wound infection which was treated with antibiotics. At the donor site, 4(16.7%), 2(8.3%), 4(16.7%) had donor site swelling, transient bleeding and soreness respectively.Conclusiondorsal onlay BMG urethroplasty has a good success rate and minor complications and therefore suitable for long segment bulbar urethral strictures.

Outcome determinants of urethroplasty in the management of inflammatory anterior urethral strictures.

Limited data are available on outcomes of the surgical management of inflammatory urethral strictures secondary to infection, a major cause of stricture. Several shortcomings that need to be addressed have been identified in the past. To determine the impact of stricture length, position and degree of obliterative urethral lumen on the surgical outcomes of corrective procedures for inflammatory anterior urethral strictures. This retrospective analysis used the records of patients who presented with proven infective anterior urethral strictures at an academic hospital from 2007 to 2010. All patients were followed up after 48 months. Urethroplasty outcomes were analysed according to stricture location and length and effect of urethral obliteration. The median age of the 174 patients in the study was 47 (range 21 - 86) years. Anastomotic urethroplasty was successful in 59/99 (59.6%) patients. Augmented anastomotic urethroplasty was successful in 11/15 (73.3%) patients. Dorsal onlay buccal mucosa graft urethroplasty was successful in 23/32 (71.9%) patients, significantly higher than in 2/9 (22.2%) patients who underwent ventral onlay buccal mucosa graft urethroplasty (p=0.017; hazard ratio 3.4; 95% confidence interval 1.29 - 9.40). The one-stage circular pedicled penile skin-flap urethroplasty was successful in 1/12 (8.3%) patients. Two-stage urethroplasty was successful in 5/7 (71.4%) patients. A primary component analysis of the 73 failed procedures showed that stricture length was the main contributor to failure (eigenvalue 1.79; 45%). Urethroplasty remains a challenge in inflammatory urethral strictures, where stricture length was the main reason for treatment failure.

Outcome Predictors of Augmentation Urethroplasty Using Dorsal Onlay Buccal Mucosal Graft

Background: The incidence and timing of stricture recurrence and factors affecting urethroplasty outcomes remains incompletely characterized. Objective: To evaluate and determine the factors predicting the outcome of dorsal onlay buccal mucosal graft (BMG) urethroplasty. Patients and Methods: We analyzed the records of 115 patients underwent dorsal onlay BMG urethroplasty at Al-Azhar University Hospitals in Cairo, Egypt, from January 2015 to April 2018, with a minimum of 12 months of followup. The risk factors examined were patient age, stricture etiology, site, length, width, diabetes, hypertension, smoking, obesity, previous visual internal urethrotomy (VIU) and urethroplasty, early postoperative complications, extravasation at first periurethral ascending cystourethrogram (ACUG) and stricture width. Results: Average patients age was 38 years. Stricture free rate was 90.4% and mean followup period was 47.5 months (range 12 to 67). Average stricture length was 5.9 cm, average stricture width was 6.3 mm, 63.4% of patients were with previous VIU, and 9.5% were with previous urethroplasty. On univariate analysis, etiology, site of stricture, previous four or more times VIU, DM, obesity, stricture length, postoperative (post op.). wound infection and leakage at first periurethral ACUG were associated with stricture recurrence. On multivariate analysis panurethral stricture (HR 280.6, 95% CI 9.1-8622.8, p =0.001), traumatic stricture (HR 17.1, 95% CI 2.4-123.4, p =0.005) were independent predictors of stricture recurrence. Stricture width, previous urethroplasty, the number of failed endoscopic procedures less than 4 times, smoking, HTN and patient age did not affect the recurrent stricture rate. Conclusion: panurethral and traumatic strictures were independent predictors of stricture recurrence.

Dorsal buccal graft urethroplasty in female urethral stricture disease: a multi-center experience.

Female urethral stricture disease is under-recognized and is often treated with dilation despite poor definitive outcomes. Our objective was to describe a multi-institutional experience treating female urethral stricture disease with female dorsal onlay buccal mucosa graft (FD-BMG) urethroplasty outcomes. We retrospectively identified 39 consecutive FD-BMG urethroplasty operations performed by 6 reconstructive surgeons from 12/2007 to 1/2016. Surgical technique included dorsally-placed buccal mucosal grafts in all cases. Stricture recurrence was defined by cystoscopy. Mean age was 50 (range, 29-81) years. Stricture etiology was unknown (49%), iatrogenic (36%), or trauma/straddle injury (15%). A majority of women (87%) women had undergone a prior stricture-related urethral procedure(s) before the surgeons' index urethroplasty. Mean stricture length was 2.1 cm and mean caliber was 11 Fr. Mean postoperative follow-up was 33 (range, 7-106) months. Postoperative complications within 30 days were seen in 7 individuals (18%) and were all Clavien-Dindo grade II. Stricture recurrence was seen in 9 (23%) patients, with mean time to recurrence 14 months. No patients experienced de novo incontinence. FD-BMG urethroplasty is a safe and effective management option for female urethral strictures. Referral to a reconstructive center is encouraged to avoid repeated unnecessary endoscopic procedures that have poor definitive success.

Single stage repair with buccal mucosal graft in hypospadias cripple patients

Background: Hypospadias surgery has developed into a well-defined art and science. Surgeons dealing with this anomaly should have detailed understanding of various basic surgical principles and experience with delicate, precise optically assisted techniques and maintain a clinical workload that is sufficient to obtain consistently good results. Objective of this study was to evaluate the outcome of using buccal mucosal graft for single stage repair in adult hypospadias cripples.Methods: All patients with prior failed hypospadias repair after multiple surgeries presenting in MLN Medical College, Allahabad were included in study. Dorsal onlay buccal mucosa graft with parallel turn over flap from penile skin for ventral surface method was used.Results: Total 20 patients were included in study. Among these 12 patients presented with complete dehiscence of repair, 5 patients presented with multiple urethrocutaneous fistulas, 3 patients presented with extensive stricture formation. Same surgeon performed procedure of dorsal onlay buccal mucosa graft urethroplasty to reduce the bias. Success rate of dorsal onlay substitution free buccal mucosal graft urethroplasty in single stage is affected by scarring of surrounding penile skin. Most common complication related to donor site are transient pain and swelling and to graft site are stricture and fistulas.Conclusions: Single stage repair with buccal mucosal graft in hypospadias cripple patients is an excellent free graft urethroplasty in cases with prior failed primary repair of hypospadias, in whom the preputial skin was lacking or insufficient and a longer urethral tube needed to be constructed.

Urethroplasty After Urethral Urolume Stent: An International Multicenter Experience

To evaluate the outcomes and factors affecting success of urethroplasty in patients with stricture recurrence after Urolume urethral stent. This is a retrospective international multicenter study on patients treated with urethral reconstruction after Urolume stent. Stricture and stent length, time between urethral stent insertion and urethroplasty, age, mode of stent retrieval, type of urethroplasty, complications and baseline, and posturethroplasty voiding parameters were analyzed. Successful outcome was defined as standard voiding, without need of any postoperative adjunctive procedure. Sixty-three patients were included. Stent was removed at urethroplasty in 61 patients. Reconstruction technique was excision and primary anastomosis in 14 (22.2%), dorsal onlay buccal mucosa graft (BMG) in 9 (14.3%), ventral onlay BMG in 6 (9.5%), dorsolateral onlay BMG in 9 (14.3%), ventral onlay plus dorsal inlay BMG in 3 (4.8%), augmented anastomosis in 5 (7.9%), pedicled flap urethroplasty in 6 (9.5%), 2-stage procedure in 4 (6.4%), and perineal urethrostomy in 7(11.1%). Success rate was 81% at a mean 59.7 ± 63.4 months. Dilatation or internal urethrotomy was performed in 10 (15.9%) and redo-urethroplasty in 5 (7.9%). Total International Prostate Symptom Score, quality of life, urine maximum flow, and postvoid residual significantly improved (P <.0001). Complications occurred in 8 (12.7%), all Clavien-Dindo ≤2. Disease-free survival rate after reconstruction was 88.1%, 79.5%, and 76.7% at 1, 3, and 5 years, respectively. Explant of individual strands followed by onlay BMG is the most common approach and was significantly advantageous over the other techniques (P = .018). Urethroplasty in patients with Urolume urethral stents is a viable option of reconstruction with a high success rate and very acceptable complication rate. Numerous techniques are viable; however, urethral preservation, tine-by-tine stent extraction, and use of BMG augmentation produced significantly better outcomes.

Management of long segment anterior urethral stricture (≥ 8cm) using buccal mucosal (BM) graft and penile skin (PS) flap: outcome and predictors of failure.

ABSTRACTPurposeTo evaluate the surgical outcome and predictors of failure of substitution urethroplasty using either dorsal onlay buccal mucosal (BM) graft or ventral onlay penile skin flap (PS) for anterior urethral stricture ≥ 8cm.Patients and methodsBetween March 2010 and January 2016, 50 patients with anterior urethral stricture ≥ 8 cm were treated at our hospital. The surgical outcome and success rate were assessed. The predictors of failure were analyzed using multivariate analysis. Failure was considered when subsequent urethrotomy or urethroplasty were needed.ResultsDorsal onlay BM graft was carried out in 24 patients, while PS urethroplasty in 26 patients. There was no significant difference between both groups regarding patients demographics, stricture characteristics or follow-up period. One case in the BM group was lost during follow-up. Stricture recurrence was detected in 7 (30.4%) patients out of BM group while in 6 (23.1%) patients out of PS group (p value= 0.5). No significant differences between both groups regarding overall early and late complications were observed. Occurrence of early complications and the stricture length were the only predictors of failure in univariate analysis, while in multivariate analysis the occurrence of early complications was only significant.ConclusionOn short-term follow-up, both dorsal onlay BM graft and ventral onlay PS flap urethroplasty have similar success rates. However, BM graft has a potential advantage to reduce operative time and is also technically easier. The surgeon should avoid early local complications as they represent a higher risk for failure.

Describing the learning curve for bulbar urethroplasty.

BackgroundLearning curves have been described for a number of urological procedures including radical prostatectomy and laparoscopic nephrectomy but rarely for urethroplasty. We describe the learning curve for bulbar urethroplasty in a single surgeon series.MethodsA retrospective case note review was performed of 91 consecutive men median age 32 years (range, 15–66 years) having bulbar urethroplasty performed by a single surgeon. Data was collected on type of urethroplasty, restricture rate (as defined by urethrogram and/or flow rate) and duration of follow up. The restricture rates were compared by quartiles and statistical analysis was by ¦Ö2 between the first and fourth quartiles.ResultsThe 91 men had 42 dorsal onlay buccal mucosal graft (Dorsal BMG), 20 BMG augmented bulbobulbar anastomotic (Augmented Rooftop) and 29 bulbobulbar anastomotic (BBA) urethroplasties performed. Median follow up was 39 months for the first quartile, 42 months for the second, 36 months for the third, and 35 months for the fourth. The restricture rate was 17% in the first quartile, 8.7% in the second and third quartiles and 4.5% in the fourth quartile. There were no restrictures noted after 24 months. There were 4 restrictures in the first quartile and 1 restricture in the fourth quartile (¦Ö2 P<0.01).ConclusionsThere is a statistically and clinically significant difference in restricture rates between first and fourth quartiles with rates falling from 17% to 4.5%. There is a learning curve for bulbar urethroplasty with a reduced restricture rate each quartile and it may take as many as 90 cases to reach optimum restricture rates.

Dorsal Onlay Buccal Mucosal Graft Urethroplasty for Bulbar Urethral Stricture- Experience of 20 Cases

Objective: To assess the success of buccal mucosal graft (BMG) urethroplasty by the dorsal onlay technique in bulbar urethral stricture.Materials and Methods: From July 2008 to June 2010, twenty patients with anterior urethral strictures were managed by dorsal onlay BMG urethroplasty. After voiding trial, they were followed up at 3 weeks and 3 months with history, physical examination, uroflowmetry and retrograde urethrogram (RGU) if required. Patients were further followed-up at 3 months interval with uroflowmetry and retrograde urethrogram (RGU) if required. Successful outcome was defined as normal voiding with no surgical intervention after catheter removal.Results: Mean stricture length was 3.5 ± 0.8 cm and mean follow up was 12 months (range 6 to 24 months). Two patients were found to develop stricture at anastomotic site, during followup and required optical internal urethrotomy and was considered as failure. One patient developed wound infection which resolved after regular dressing. Success rate was 90%.Conclusion: Dorsal onlay BMG urethroplasty is a simple technique with good surgical outcome.J Dhaka Medical College, Vol. 26, No.1, April, 2017, Page 8-11

V1-03 MEMBRANOUS URETHROPLASTY USING DORSAL ONLAY BUCCAL MUCOSAL GRAFT FOR STRICTURES ASSOCIATED WITH TURP OR RADIATION THERAPY

You have accessJournal of UrologyReconstruction Lower Tract (I)1 Apr 2017V1-03 MEMBRANOUS URETHROPLASTY USING DORSAL ONLAY BUCCAL MUCOSAL GRAFT FOR STRICTURES ASSOCIATED WITH TURP OR RADIATION THERAPY Stephen Blakely, Daniela Kaefer, Michael Daugherty, and Dmitriy Nikolavsky Stephen BlakelyStephen Blakely More articles by this author , Daniela KaeferDaniela Kaefer More articles by this author , Michael DaughertyMichael Daugherty More articles by this author , and Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.235AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To present the application of buccal mucosa graft dorsal onlay urethroplasty for membranous urethral stricture caused by TURP or radiation therapy. METHODS All patients were confirmed to have membranous involvement using radiographic and endoscopic evaluation. Dorsal onlay urethroplasty via a one-sided urethral dissection as described by Kulkarni and Barbagli was performed in all patients. This technique was modified by carrying dorsal urethrotomy proximally through the membranous urethra and sharply excising a wedge of intracrural tissue beyond stricture area to make adequate room for buccal mucosa grafting. All patients were followed at 4, 8, 12 months and then yearly for assessment of functional and patient-reported outcomes. RESULTS Fifteen consecutive men with a mean age 68 years (47-72) post membranous urethral stricture repair were included. Seven patients had prior TURP, 6 had prior radiation therapy with prostate in situ, and 2 patients had radical prostatectomy followed by adjuvant radiation therapy. At a mean of 17 months (4-37) follow up, one patient required an additional procedure for stricture recurrence. No patient developed de novo incontinence. Improvement was seen with respect to mean maximum flow rate (4 to 21 cc/sec), PVR (90 to 50 cc), and International Prostate Symptom Scores (23 to 9). CONCLUSIONS Membranous urethral strictures can be effectively treated using this buccal mucosa graft dorsal onlay technique which avoids extensive urethral mobilization, urethral transection, and perirectal dissection. The described technique did not compromise continence in this group of patients. Additionally, in this series dorsal buccal mucosal graft take is demonstrated in patients with prior history of radiation therapy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e68 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Stephen Blakely More articles by this author Daniela Kaefer More articles by this author Michael Daugherty More articles by this author Dmitriy Nikolavsky More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Augmented perineal urethrostomy using a dorsal buccal mucosal graft, bi-institutional study.

To present our technique and outcomes for perineal urethrostomy augmented with a dorsal onlay buccal mucosa graft (BMG). Results from initial series and collaboration from an international center are included. A retrospective chart review of all adult patients who underwent urethral reconstruction with perineal urethrostomy utilizing a buccal mucosal graft between January 1, 2002 and January 1, 2013 was performed. All surgeries were performed by three surgeons using the same technique (GHJ, KAM, and RV). Success was defined as no need for additional treatment following definitive surgery. A total of 44 patients met inclusion criteria. Mean patient age was 60 (range 44-81) years. All strictures were pananterior. Etiologies included unknown in 16 (36%), failed hypospadias repair in six (14%), lichen sclerosus in ten (23%), iatrogenic in seven (16%), Fournier's in three (7%), urethral cancer in one (2%) and penile cancer in one (2%). Mean follow-up was 45 (range 6-136) months. Overall success was 80%. Nine patients recurred, of which four had a successful revision, two are awaiting potential revision, and three are being managed with periodic dilations. BMG perineal urethrostomy is a valid alternative for complex urethral strictures due to lichen sclerosus, previous failed reconstructions or hypospadias cripples. Midterm results are encouraging for this novel technique.

Dorsal Onlay Buccal Mucosal Graft Urethroplasty for Bulbar Urethral Stricture- Experience Of 20 Cases

Objective: To assess the success of buccal mucosal graft (BMG) urethroplasty by the dorsal onlay technique in bulbar urethral stricture.Materials and Methods: FromJuly 2008 to June 2010, twenty patients with anterior urethral strictures weremanaged by dorsal onlay BMG urethroplasty. After voiding trial, they were followed up at 3 weeksand 3 months with history, physical examination, uroflowmetryand retrograde urethrogram (RGU) if required. Patients were furtherfollowed-up at 3 months interval with uroflowmetry and retrograde urethrogram (RGU) if required. Successfuloutcome was defined as normal voiding with no surgical intervention after catheter removal.Results: Mean stricture length was 3.5 ± 0.8 cm and mean follow up was 12 months (range 6 to 24 months). Twopatients were found to develop stricture at anastomotic site, during followup and required optical internal urethrotomy and was considered as failure.One patient developed wound infection which resolved after regular dressing. Success rate was 90%.Conclusion: Dorsal onlay BMG urethroplasty is a simple technique with good surgical outcome.J Dhaka Medical College, Vol. 23, No.2, October, 2014, Page 175-178

Dorsal versus ventral onlay buccal mucosal graft urethroplasty for long-segment bulbar urethral stricture: A prospective randomized study.

To compare safety and efficacy of ventral versus dorsal onlay buccal mucosal graft urethroplasty in patients with long-segment incomplete bulbar urethral stricture. This was a single center, prospective, randomized trial. Patients with long-segment (>2cm) incomplete bulbar urethral stricture and meeting eligibility criteria were enrolled in the study. They were randomized into two study groups: group A undergoing dorsal onlay buccal mucosal graft urethroplasty and group B undergoing ventral onlay buccal mucosal graft urethroplasty. The two groups were compared statistically with regard to International Prostate Symptom Score, maximum flow rate, intraoperative parameters and complications. A total of 80 eligible patients were randomized into two equal groups of 40 patients each. The preoperative International Prostate Symptom Score, maximum flow rate and intraoperative parameters were not significantly different between the two groups. At 12-month follow up, the mean International Prostate Symptom Score showed 324.95% and 353.59% improvement, whereas the mean maximum flow rate showed 208.43% and 201.93% improvement in groupA and B, respectively. There was no significant difference between International Prostate Symptom Score and maximum flow rate data between the two groups at 3- and 12-month follow up. The success rate of surgery was similar between groupA and B (92.5% vs 90%) with no significant difference noted between them. Dorsal and ventral onlay buccal mucosal graft urethroplasty have comparable efficacy and complication rates for treatment of long-segment incomplete bulbar urethral strictures.