Dorsal Onlay Buccal Mucosal Graft Research Articles

Comparison Of Ventral Inlay and Dorsal Onlay Urethroplasty For Female Urethral Stricture

ObjectiveTo compare the outcomes of Ventral inlay buccal mucosal graft urethroplasty (VIBMGU) with dorsal onlay buccal mucosal graft urethroplasty (DOBMGU) for the treatment of Female urethral stricture (FUS). Material and MethodsThis study included women who underwent either VIBMGU or DOBMGU between January 2016 and June 2023. The preoperative AUA symptom scores, maximal urinary flow rate (Qmax), post-void residual volume (PVR) on ultrasonography, and length and location of the stricture were obtained from a prospectively maintained electronic database. The data obtained from the patient’s last visit was compared with the preoperative values for this study. The primary outcome was the success rate. The secondary outcomes were changes in AUA score, PVR, and Qmax. The patient's last follow-up visit was considered for the duration of the follow-up. ResultsSeventy-three patients were treated for BMGU for FUS. Forty-six patients underwent VIBMGU, and 27 patients underwent DOBMGU. The median duration of follow-up was 27.5 11.00-55.00) versus 14 (7.00-17.00) months respectively. The success rates of VIBMGU and DOBMGU were 89.13% and 88.89% respectively. There was a reduction in AUA scores and PVR and an improvement in Qmax postoperatively in both groups. The difference in the reduction in AUA scores between the VIBMGU and DOBMGU groups was statistically significant. The difference was not statistically significant in terms of reduction in PVR and improvement in Qmax between the two groups. ConclusionThe ventral inlay technique can provide equal results to the dorsal technique with the added advantage of vaginal sparing. This is the single largest series in the literature on female urethral stricture with the largest follow-up period of 90 months.

Multi-Institutional Outcomes of Dorsal Onlay Buccal Mucosal Graft Urethroplasty in Patients With Postprostatectomy, Postradiation Anastomotic Stenosis.

The treatment of urethral stenosis after a combination of prostatectomy and radiation therapy for prostate cancer is understudied. We evaluate the clinical and patient-related outcomes after dorsal onlay buccal mucosal graft urethroplasty (D-BMGU) in men who underwent prostatectomy and radiation therapy. A multi-institutional, retrospective review of men with vesicourethral anastomotic stenosis or bulbomembranous urethral stricture disease after radical prostatectomy and radiation therapy from 8 institutions between 2013 to 2021 was performed. The primary outcomes were stenosis recurrence and development of de novo stress urinary incontinence. Secondary outcomes were surgical complications, changes in voiding, and patient-reported satisfaction. Forty-five men were treated with D-BMGU for stenosis following prostatectomy and radiation. There was a total of 7 recurrences. Median follow-up in patients without recurrence was 21 months (IQR 12-24). There were no incidents of de novo incontinence, 28 patients were incontinent pre- and postoperatively, and of the 6 patients managed with suprapubic catheter preoperatively, 4 were continent after repair. Following repair, men had significant improvement in postvoid residual, uroflow, International Prostate Symptom Score, and International Prostate Symptom Score quality-of-life domain. Overall satisfaction was +2 or better in 86.6% of men on the Global Response Assessment. D-BMGU is a safe, feasible, and effective technique in patients with urethral stenosis after a combination of prostatectomy and radiation therapy. Although our findings suggest this technique may result in lower rates of de novo urinary incontinence compared to conventional urethral transection and excision techniques, head-to-head comparisons are needed.

Dorsal onlay buccal mucosal graft urethroplasty for female urethral stricture: Techniques and outcomes

ObjectiveFemale urethral stricture (FUS) accounts for about 4%–13% of cases of female bladder outlet obstruction. FUS was and is still managed by repeated dilatations and/or direct visual internal urethrotomy. There are many alternative options for reconstruction like buccal or vaginal mucosal graft urethroplasty. Our aim was to describe the technique of dorsal onlay buccal mucosal graft (BMG) urethroplasty for FUS and present the outcomes. MethodsBetween January 2014 and December 2021, 37 patients who underwent dorsal onlay BMG urethroplasty were included in the study. Their pre-operative diagnosis was confirmed with uroflowmetry, micturating cystourethrogram, urethral calibration, and on table cystoscopy. Bladder catheter was removed after 2 weeks. Patients were followed up at 3 months, 6 months, 1 year, and then annually with urine analysis, uroflowmetry, and post-void residual assessment. We defined success as a maximum flow rate (Qmax) above 15 mL/s without the need for an additional instrumentation. ResultsThe mean age of patients was 47.8 (standard deviation [SD] 11.3) years. Twenty patients had previously undergone urethral dilatations. The mean pre-operative Qmax was 7.79 (SD 3.73) mL/s. However, the mean Qmax improved to 23.20 (SD 8.25) mL/s after surgery. The mean post-void residual urine after surgery was 30.50 (SD 10.70) mL. This reduced from a mean value of 139.00 (SD 147.24) mL before surgery. The mean follow-up was 30.2 (SD 18.3, range 18–44) months. There was no post-operative incontinence. There were Clavien–Dindo Grade 1 complications in 6 out of 37 (16.2 %) patients during hospital stay. The only long-term complication was recurrence of stricture in 4 (10.8%) patients. ConclusionDorsal onlay BMG urethroplasty in females is a safe, effective technique which can avoid repeated painful dilatations and multiple urethrotomies. One should always consider reconstruction in FUS without any fear of incontinence.

Circular Penile Skin Fasciocutaneous Ventral Onlay Flap Urethroplasty as an Alternative to Dorsal Onlay Buccal Mucosal Graft Urethroplasty in Complex Long-Segment Urethral Stricture: A Retrospective Study.

Background A urethral stricture is the narrowing of the urethra that results in symptoms of obstruction. It can appear anywhere along the male urethra's length and has a variety of causes.The circular penile fasciocutaneous flap is employed in the successful single-stage reconstruction of long-segment complex anterior urethral strictures especially when the buccal mucosa is unavailable due to various reasons.The study has tried to identify a surgical technique that is more beneficial for the treatment of urethral strictures. Objective The objective of this research was to evaluate the outcomes of circular penile skin fasciocutaneous ventral onlay flap urethroplasty (group A) and the outcomes of dorsal onlay buccal mucosal graft urethroplasty (group B) in the management of complex long-segment penile urethral stricture. Methods In this retrospective study between December 2012 and December 2022, 60 patients with long-segment complex penile urethral stricture who underwent urethroplasty at our center were evaluated. Patients were divided into two groups according to the flap used (dorsal onlay buccal mucosal graft urethroplasty was used in 30 patients (group B), and circularpenile fasciocutaneous flap (single stage) was used in 30 patients (group A)). The success rate and the mean peak flow rate were also calculated post-operation to identify the effectiveness of the surgical procedure used for urethral strictures. Results The study consisted of 60 patients in total. Group A's mean age was determined to be 51.2±16.2 years, whereas group B's mean age was determined to be 40.7±16.8 years. Preoperatively, the median urethral stricture length was 69 mm in group A (range: 20-100 mm) and 56 mm in group B (range: 30-110 mm). The intraoperative median length of the urethral stricture was 82 mm in group A (range: 20-120 mm) and 65 mm in group B (range: 40-140 mm). The mean peak flow rate was 30.9±6.8mL/s in group A compared to 18.1±4.9mL/s in group B. The success ratefor group A was 89.7%, while the success rate forgroup Bwas 75.9%. Conclusion For complexlong-segment urethral strictures, circular penile skin fasciocutaneous ventral onlay flap urethroplasty has a higher rate of success and fewer complications than dorsal onlay buccal mucosal graft urethroplasty. Along with success rate, it has a better mean peak flow rate and lower complications.

Female urethroplasty with dorsal onlay buccal mucosal graft: a single institution experience

PurposeFemale urethral stricture disease is frequently unrecognized or misdiagnosed, with controversy in the literature regarding the definition of strictures and approach to management. The purpose of this study is to report our institutional experience with female urethroplasty and add our experience to the growing body of research.MethodsWe performed a retrospective review of patients undergoing female urethroplasty with dorsal onlay BMG at the University of Colorado between March 2015 and December 2021 performed by two surgeons (BF and JO). The primary outcome measure was surgical success, defined as no stricture recurrence. The secondary outcome measure was the incidence of de novo urinary incontinence.Results23 patients were included in our data analysis. The median duration of lower urinary tract symptoms prior to urethroplasty was 16 years. 87% had undergone previous dilations. At a median follow-up of 12.2 months (range 1–81 months), four patients required a secondary procedure for obstruction with an overall success rate of 83%. One patient developed de novo stress urinary incontinence and one patient developed urge urinary incontinence. Subgroup analysis was performed comparing the patients that developed stricture recurrence (N = 4) to those that did not (N = 19). Those with stricture recurrence had a longer duration of symptoms and more dilations prior to urethroplasty.ConclusionFemale urethroplasty with BMG is effective at treating female urethral stricture disease, with excellent outcomes at over a year of follow-up and minimal risk of stress incontinence postoperatively.

MP22-07 OUTCOMES OF DORSAL ONLAY BUCCAL MUCOSAL GRAFT URETHROPLASTY IN PATIENTS WITH POST-PROSTATECTOMY, POST-RADIATION ANASTOMOTIC CONTRACTURE

You have accessJournal of UrologyCME1 May 2022MP22-07 OUTCOMES OF DORSAL ONLAY BUCCAL MUCOSAL GRAFT URETHROPLASTY IN PATIENTS WITH POST-PROSTATECTOMY, POST-RADIATION ANASTOMOTIC CONTRACTURE Joshua Sterling, Alex Wang, Kelly Crane, Javier C. Angulo, Wagner Franca, Brian Flynn, Francisco Martins, Erick A. Ramirez, Paul Rusilko, Jay Simhan, Daniel Swerdloff, and Dmitriy Nikolavsky Joshua SterlingJoshua Sterling More articles by this author , Alex WangAlex Wang More articles by this author , Kelly CraneKelly Crane More articles by this author , Javier C. AnguloJavier C. Angulo More articles by this author , Wagner FrancaWagner Franca More articles by this author , Brian FlynnBrian Flynn More articles by this author , Francisco MartinsFrancisco Martins More articles by this author , Erick A. RamirezErick A. Ramirez More articles by this author , Paul RusilkoPaul Rusilko More articles by this author , Jay SimhanJay Simhan More articles by this author , Daniel SwerdloffDaniel Swerdloff More articles by this author , and Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002561.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Treatment of patients with vesicourethral anastomotic contracture (VUAS) /membranous stenosis (Sp) following a combination of prostatectomy and radiation treatment for prostate cancer (CaP) are understudied. We evaluate feasibility of dorsal onlay buccal mucosal graft urethroplasty (D-BMGU) and evaluate patency and continence outcomes in patients with a history of prior radical prostatectomy and radiation therapy. METHODS: Retrospective multi-institutional review of patients with post-prostatectomy, post-radiation VUAS/Sp from 8 institutions between 2013-2021 was performed. Patients with at least 8-months 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 recurrence and development of de-novo stress urinary incontinence (SUI). Secondary outcomes were surgical complications, changes in voiding and patient-reported satisfaction using a Global Response Assessment (GRA). RESULTS: Of 48 patients treated with D-BMGU for stenosis following prostatectomy and radiation, 38 met the inclusion criteria. Median age and stenosis length were 68.5 years, (IQR 63.25-72), and 2.75 cm (IQR 2-4 cm), respectively. Prior CaP treatment modalities included primary robotic prostatectomy and subsequent salvage or adjuvant radiotherapy in 89% (34/38) and primary radiation and salvage prostatectomy in 11% (4/38). The mean length of stay after D-BMGU was 1.5 days (IQR 1-2). At a median follow-up of 21 months (IQR 13-39), 5 patients (13%) had recurrence. Among 11 preoperatively-continent patients (31%) all retained continence. Of 20 patients with preoperative SUI (52%), all but one (95%) remained incontinent post-operatively. Continence was unknown for 7 patients and 3 had post operative incontinence. 47% (17/36) of the cohort subsequently received an artificial urinary sphincter. Patients experienced significant improvement in PVR (158 to 47 cc, p <0.001) and Uroflow (6.3 to 15.4 cc/s, p <0.001), and also reported high overall satisfaction, with 84% reporting a GRA of +2 or better. CONCLUSIONS: Dorsal onlay buccal mucosa graft urethroplasty is a safe and feasible technique in patients with post-radiation post prostatectomy anastomotic contracture. Although our findings suggest the DBMGU technique may confer lower rates of de-novo SUI compared to conventional urethral transection, head-to-head comparisons are needed to further characterize any continence benefit. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e374 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Sterling More articles by this author Alex Wang More articles by this author Kelly Crane More articles by this author Javier C. Angulo More articles by this author Wagner Franca More articles by this author Brian Flynn More articles by this author Francisco Martins More articles by this author Erick A. Ramirez More articles by this author Paul Rusilko More articles by this author Jay Simhan More articles by this author Daniel Swerdloff More articles by this author Dmitriy Nikolavsky More articles by this author Expand All Advertisement PDF DownloadLoading ...

Dorsal approach for double-face bulbar urethroplasty: ventral inlay plus dorsal onlay using Kulkarni one-side dissection.

Non-traumatic obliterative bulbar urethral stricture with residual urethral lumen below 3Fr is a challenging surgical scenario for reconstructive surgeons, because either anastomotic or single augmentation urethroplasty is not an option. To describe our double-face buccal mucosa graft (BMG) urethroplasty with dorsal onlay and ventral inlay relying on the vessels and nerve-sparing technique of Kulkarni's one-side dissection. We retrospectively reviewed a prospectively maintained database of patients with non-traumatic obliterative bulbar urethral strictures who underwent double-face bulbar urethroplasty with one-side dissection and dorsal onlay plus ventral inlay BMG. Patient demographics, clinical data, and follow-up were analyzed. A total of 59 patients underwent double-face urethroplasty with dorsal approach. The median age was 37years (IQR 27-49) and the median stricture length was 5cm (IQR 3.75-6). No patients had immediate post-operative complications. The overall success rate was 88% with a median follow-up of 30.9months (IQR 16.9-44.2). Two patients were treated with DVIU, and two patients with open urethral surgery. One patient developed erectile dysfunction after surgery. Age, etiology, stenosis length and previous treatment were not factors related to surgical failure. Our preliminary albeit encouraging results showed that this approach was feasible in all patients and with negligible perioperative complications. Success rate was 88%. We did not find any factors related to surgical failure. Our dorsal double-face augmented urethroplasty may be a valid alternative to the Palminteri's ventral double-face urethroplasty, especially in those patients with mid-distal bulbar or peno-bulbar urethral strictures.

The success of dorsal onlay buccal mucosal graft urethroplasty in challenging urethral stricture cases after multiple failed urethrotomies.

Urethroplasty is the gold standard treatment procedure for male patients with urethral stricture and is becoming increasingly popular among urologists worldwide. Procedure success rates have risen with increased experience. Here we aimed to examine the results of urethroplasty in challenging cases of urethral stricture and its effect on sexual function. Data were collected retrospectively from the patients who had undergone urethroplasty after multiple failed direct vision internal urethrotomy (DVIUs) from 2017 to 2020. All patients were monitored for a minimum of 12 months. Outcomes of urethroplasty were analyzed according to stricture location, length, and the number of prior DVIUs. Penile length and sensation, erectile, and ejaculatory function of the patients were evaluated pre- and postoperatively. The patient cohort consisted of 36 males with a mean age of 63 ± 3.2 years. The most prevalent stricture etiology was iatrogenic (83%). Patients who underwent three or more DVIUs before urethroplasty and stricture length >4 cm were included in the analysis. Accordingly, the overall success rate was 83% (30/36). When the success rate and the IIEF5 scores were assessed separately, there was no significant relationship between the number of DVIUs (P > 0.05). Similarly, no significant relationship was also found with the stricture length (P > 0.05). Appropriate and correctly applied surgical technique does not impair sexual activity, even in patients with severe urethral stricture, regardless of the length or location of the stricture and the number of prior endoscopic procedures.

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.

Multi-Institutional Study of Dorsal Onlay Urethroplasty of the Membranous Urethra after Endoscopic Prostate Procedures: Operative Results, Continence, Erectile Function and Patient Reported Outcomes

(1) Background: To critically evaluate dorsal onlay buccal mucosal graft urethroplasty (DOBMGU) for posterior urethral stenosis repair following transurethral resection and other endoscopic prostate procedures. (2) Methods: A retrospective multi-institutional review of patients with membranous or bulbomembranous urethral stenosis for whom treatment with DOBMGU was conducted after receipt of prostate endoscopic procedures. Baseline data, peri-operative care, post-operative care and patient-reported outcomes were analyzed. The primary outcomes were procedural failure and development of de novo stress urinary incontinence (SUI). The secondary outcomes were changes in voiding, sexual function and patient satisfaction. (3) Results: A total of 107 men with a mean age of 69 ± 9.5 years and stenosis length of 3.5 ± 1.8 cm were included. Prior endoscopic procedures among participants were 47 patients (44%) with monopolar TURP, 33 (30.8%) with bipolar TURP, 16 (15%) with Greenlight laser, 9 (8.4%) with Holmium laser enucleation and 2 (1.9%) with bladder neck incision. At a mean follow-up time of 59.3 ± 45.1 months, stenosis recurred in 10 patients (9.35%). Multivariate analysis confirmed that postoperative complications (OR 12.5; p = 0.009), history of radiation (OR 8.3; p = 0.016) and ≥2 dilatations before urethroplasty (OR 8.3; p = 0.032) were independent predictors of recurrence. Only one patient (0.9%) developed de novo SUI. Patients experienced significant improvement in PVR (128 to 60 cc; p = 0.001), Uroflow (6.2 to 16.8 cc/s; p = 0.001), SHIM (11.5 to 11.7; p = 0.028), IPSS (20 to 7.7; p < 0.001) and QoL (4.4 to 1.7; p < 0.001), and 87 cases (81.3%) reported a GRA of + 2 or better. (4) Conclusions: DOBMGU is an effective and safe option for patients with posterior urethral stenosis following TURP and other prostate endoscopic procedures. This non-transecting approach minimizes external urinary sphincter manipulation, thus limiting postoperative risk of SUI or erectile dysfunction.

Treatment of panurethral strictures using one side dissection dorsal onlay buccal mucosal graft urethroplasty

The management of panurethral stricture was still challenging and controversial. We presented a case of pan urethral strictures management by using a one-sided dissection of dorsal onlay buccal mucosal graft (BMG) urethroplasty (Kulkarni technique). A 53-years old man admitted with panurethral stricture who had previously undergone several procedures. Bipolar micturition cystourethrography procedure revealed 17 cm stricture length. One-sided dissection dorsal onlay buccal mucosal graft urethroplasty was performed. No drain was placed. The Foley catheter was removed four weeks after surgery, and the results of the micturition were favourable. No fistulae were found at a straight erection and meatus at a normal position. The postoperative flow rate (Qmax) was 24.9 ml/second. As a conclusion Kulkarni technique urethroplasty gained good outcome for panurethral stricture in our case.

Paediatric Buccal Mucosal Graft Urethroplasty for Non-Hypospadias Urethral Strictures: A Single Centre Experience with Long Term Outcomes

ObjectiveTo review our experience in the management of paediatric urethral strictures with buccal mucosal graft urethroplasty and its long term outcomes. MethodsThis was a retrospective analysis of a prospectively maintained data base between 2009–2019. Circumcised children with long segment urethral strictures (> 1.5 cm) were included. They were characterized as either peno-bulbar (PBS) or isolated bulbar strictures (IBS) based on a standardized protocol. All children underwent single stage dorsal onlay buccal mucosal graft urethroplasty by either the Kulkarni technique (PBS group) or the Barbagli technique (IBS group). All children were followed up at 3 months, then annually thereafter with flow rates at each visit. Success was defined as a flow rate > 10ml/sec with a bell-shaped curve and absence of need for any secondary procedures. Results28 children underwent buccal mucosal graft uretheroplasty.16 children were diagnosed with PBS & 12 children with IBS. The median age was 7.5 years (2–17 years) in PBS and 5.5 years (3–10 years) in IBS. Iatrogenic injury was the commonest aetiology ie 71 % (20/28). Mean length of stricture was 4 cm (3–5.5 cm) in PBS and 2.5 cm (2–3.5 cm) in IBS. Median follow up was 96 months (24-120 months) in PBS and 90 months (36-120 months) in IBS. The success rate was 87.5% (14/16) in PBS and 83.3% (10/12) in IBS. ConclusionSingle stage dorsal on lay buccal mucosal graft urethroplasty, ie Kulkarni and Barbagli techniques are safe and feasible in children with long segment urethral strictures with good long-term outcomes.

One-Stage Buccal Mucosal Graft Urethroplasty for Lichen Sclerosus-Related Urethral Stricture Disease: A Systematic Review and Pooled Proportional Meta-Analysis.

Performing 1-stage urethroplasty in patients with urethral strictures caused by lichen sclerosus (LS) is hotly debated among reconstructive urologists due to conflicting reports of success. Therefore, the objective of this study was to determine the pooled incidence of stricture recurrence following 1-stage buccal mucosal graft (BMG) urethroplasty in patients with LS, to determine the impact of surgical technique on recurrence and to compare recurrence risk between patients with and without LS after 1-stage repairs. A systematic review was conducted in accordance with PRISMA criteria. The primary outcome was pooled incidence of recurrence, which was calculated using a Der-Simonian-Laird binary random effects model with a Freeman-Tukey arcsine transformation. A total of 21 studies were included, of which 15 provided data for comparative analyses. Pooled data from 625 LS patients revealed a stricture recurrence rate of 10% (95% CI 6-14). Among studies with longer followup (≥24 months), this increased to 18%. Among patients with penile urethral involvement, studies utilizing a penile skin incision had significantly higher pooled recurrence rates than those utilizing penile invagination (p=0.004). Across all studies, there was no evidence to suggest a difference in pooled recurrence rate between patients with and without LS (p=0.36). However, across only long-term studies, recurrence risk was significantly higher for patients with LS (OR 1.83, p=0.05). One-stage BMG urethroplasty is likely a viable surgical option for patients with LS-related strictures; however, high-quality data are limited. Future multi-institutional, long-term prospective studies are needed to assess durability of 1-stage repair.

Multicenter urethroplasty outcomes for urethral stricture disease for patients with neurogenic bladder or bladder dysfunction requiring clean intermittent catheterization.

BackgroundOur objective is to better comprehend treatment considerations for urethral stricture disease (USD) in patients requiring long-term clean intermittent catheterization (CIC). Patient characteristics, surgical outcomes and complications are unknown in this population.MethodsSix members of the Trauma and Urologic Reconstruction Network of Surgeons (TURNS) participated in a prospective (2009 to present) and retrospective (prior to 2009) database recording patient demographics, surgical approach and outcomes. We included all patients undergoing urethroplasty who perform CIC. Descriptive statistics were used to analyze results.ResultsA total of 37 patients with 39 strictures were included. Bladder dysfunction was characterized as detrusor failure in 35% and neurogenic etiology in 65%. Median stricture length was 3 cm (IQR: 1.5–5.5) with 28% repaired with dorsal onlay buccal mucosal graft, 26% excision and primary anastomosis, 8% dorsal inlay, 8% ventral and dorsal, 8% flap based 8% non-transecting and 15% other. Functional success was 90%: 4 patients required DVIU or dilation due to recurrence, with 2 of those ultimately requiring repeat urethroplasty. 86% of patients returned to CIC; no patients reported new pad use for urinary leakage after urethroplasty. During a median follow-up period of 3.1 years (IQR: 1.0–5.3), no patients underwent urinary diversion.ConclusionsUrethroplasty is suitable, safe and effective for patients dependent on CIC suffering from USD. The effect of continual CIC on long-term outcomes remains uncertain.

A single stage urethroplasty with dorsal onlay buccal mucosal graft for long segment anterior urethral stricture caused by Balanitis Xerotica Obliterance through a perineal incision

Sri Lanka Journal of Urology (SLJU) is a peer reviewed, open access journal published annually by the Sri Lanka Association of Urological Surgeons (SLAUS). The Journal commenced in 2000 as the official publication of the SLAUS since its inception in 1999. Full text articles are available.

Glans Preservation in Surgical Treatment of Distal Urethral Strictures With Dorsal Buccal Mucosa Graft Onlay by Subcoronal Approach

To describe dorsal onlay buccal mucosa graft urethroplasty technique by subcoronal approach and glans preservation in distal penile urethral strictures with fossa navicularis involvement and to report safety, effectiveness, and cosmetic outcomes. Retrospective review of a prospective database of patients treated at Hospital Italiano de Buenos Aires between January 2011 and December 2019. Main surgical steps: ventral subcoronal incision, dorsal dissection of glandelar urethra until piercing the tip of the glans, dorsal urethrotomy, and graft transposition. Low urinary tract symptoms, uroflowmetry, and urinalysis were assessed at follow-up. Simplified International Index Erectile Function and Hypospadias Objective Scoring Evaluation were applied 1 year after surgery. Sixteen patients with a median age of 56.5 years (IQR 35.7-66.7) were included. Median stricture length was 5.5 cm (IQR 4-8.7). In 3 patients, Clavien-Dindo grade I-II complications were reported. At 1 year, median peak flow was 18 mL/seg (IQR 12.7-27.4) and median mean flow 7.8 mL/seg (IQR 6.1-9.9). At 41.5 months follow-up (IQR 13.2-74), all patients were stricture free and had no changes in erectile function. Hypospadias Objective Scoring Evaluation score ≥14 points was achieved by 14 patients (87.5%). For treatment of distal penile urethral strictures with fossa navicularis involvement, dorsal onlay buccal mucosa graft by subcoronal approach and glans preservation is a feasible technique with excellent functional outcomes, minimal complications, and substantial cosmetic results.

Factors Predicting Urethral Stricture Recurrence after Dorsal Onlay Augmented, Buccal Mucosal Graft Urethroplasty

Introduction: This study was carried out to identify the predictors of urethral stricture recurrence after dorsal onlay buccal mucosal graft (BMG) urethroplasty. Materials and Methods: The medical records of patients with anterior urethral stricture who underwent dorsal onlay BMG urethroplasty at a single tertiary medical center during the period from March 2010 to January 2018 were reviewed. Only patients with ≥2-year follow-up were included. Data regarding patient demographics, clinical characteristics, stricture characteristics, postoperative course, and adverse events were recorded. Kaplan-Meier analysis was used to assess the recurrence-free survival and likelihood of stricture recurrence. Cox regression analysis was used to identify potential independent predictors of stricture recurrence. Results: This study included 266 patients with a mean age of 37.71 years and a mean follow-up period of 49.77 months. From the overall study cohort, 34 (12.8%) reported stricture recurrence and 232 (87.2%) were not. The mean recurrence-free time was 79.93 months and mean time to recurrence was 21.59 months. On multivariate analysis, obesity (hazard ratio (HR): 6.02; 95% conference interval (CI): 1.91, 19.03: p = 0.002), inflammatory aetiology (HR: 9.13; 95% CI: 3.50, 23.81; p < 0.001), prior urethroplasty (HR: 8.81; 95% CI: 3.26, 23.86; p < 0.001), penile stricture location (HR: 3.09; 95% CI: 1.10, 8.71; p = 0.033), and stricture length >4.5 cm (HR: 6.83; 95% CI: 1.69, 27.62; p = 0.007) were the significant independent predictors of stricture recurrence. Conclusions: Dorsal onlay BMG urethroplasty has a reasonable recurrence-free rate with acceptable postoperative complications. Obesity, inflammatory etiology, prior urethroplasty, penile stricture location, and longer stricture were the factors associated with urethral stricture recurrence.

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 (&gt; 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 &lt;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.