Onlay Buccal Mucosal Graft Urethroplasty Research Articles

Decision regret and long-term success rates after ventral buccal mucosa graft urethroplasty.

To characterise the long-term success rate of ventral onlay buccal mucosa graft urethroplasty (vBMG) in the management of bulbar urethral stricture disease (USD), assess patient-reported postoperative satisfaction and decision regret, and delineate clinical factors impacting patient-reported metrics. Patients with prior vBMG for bulbar USD, performed at Cleveland Clinic between 2003 and 2022, were contacted and brief structured interviews were performed. Stricture recurrence and need for secondary procedures, baseline demographics, and patient-reported outcome surveys were collected. The surveys included the Decision Regret Scale (DRS), the Urethral Stricture Symptom Impact Measure (USSIM) and the 10-item Patient-Reported Outcomes Measurement Information System Short Form, version 1.2 (PROMIS-10). Descriptive, univariate and multivariable analyses were performed for clinical outcomes and survey responses. A total of 104 patients recorded responses. The median patient age was 49 years and the median follow-up was 7.4 years at time of survey. The median graft length was 5 cm and 38% of patients underwent partial thickness augmented anastomotic urethroplasty. At time of follow-up, 10 patients underwent a secondary procedure. Moderate to severe regret on the DRS was found in 12% of patients, and greater regret was associated with recurrence. The mean physical and mental health PROMIS-10 Global Health T-scores were 52 and 53. The mean total USSIM score was 56. A significant correlation was found between USSIM and DRS scores, with higher DRS score and recurrence negatively impacting USSIM score. USSIM scoring across all domains was significantly worse in the moderate to severe DRS group. This study showed that vBMG for bulbar USD confers both high success rates and patient-reported satisfaction at extended follow-up, based on emerging and validated patient-reported outcome measures.

259 - Ventral inlay versus dorsal onlay buccal mucosal graft urethroplasty for female urethral stricture; Randomized control trial

259 - Ventral inlay versus dorsal onlay buccal mucosal graft urethroplasty for female urethral stricture; Randomized control trial

Reply to Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

Reply to Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

Ventral Onlay Buccal Mucosa Graft Urethroplasty for Female Urethral Stricture: Medium-term Results in a Single Surgeon Experience

ObjectiveTo describe our own approach using buccal mucosal grafting and to assess the outcome of this approach. Materials and MethodsA total of 42 patients underwent ventral onlay BMG by a single surgeon between 2017 and 2022. A longitudinal incision along the length of the urethra was made through the anterior vaginal wall and the peri-urethral fascia was incised to create two flaps. This ventral urethrotomy ran from the meatus into the proximal health urethra above the level of the stricture.A buccal mucosal graft was harvested and sutured to the margins of the urethral mucosa itself and the flaps of peri-urethral fascia. The vaginal wall was then closed. ResultsThe mean age of the patients was 53.6 ± 12.8 years. There were no perioperative or postoperative complications. At a mean follow-up of 38.1 months, 41 patients (98%) were stricture-free. Peak flow rate improved from a mean of 7.7 ± 3.2 ml/s preoperatively to 25.9 ± 5.9 ml/s postoperatively. No patient developed incontinence. One patient developed a recurrent urethral stricture which was treated by redo urethroplasty. ConclusionsThe surgical technique applied has proved efficiency. The ventral BMG preserves the urethral sphincter and so avoids postoperative incontinence. The use of peri-urethral fascia represents a good vascular and mechanical support for the graft.

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.

Outcomes of Ventral Onlay Buccal Mucosal Graft Urethroplasty in Bulbomembranous Urethral Strictures Post-transurethral Resection of the Prostate

ObjectivesTo evaluate the outcomes of Ventral Onlay Buccal Mucosal Graft Urethroplasty (VOBMGU) in bulbomembranous urethral strictures after transurethral resection of the prostate (TURP). MethodsAfter approval of the institutional ethical committee, we retrospectively examined the database of patients diagnosed with PTS and treated by VOBMGU from January 2020 to January 2022. The patients were evaluated by retrograde urethrogram (RUG) and voiding cystourethrogram (VCUG). Follow-up evaluation included assessment of lower urinary tract symptoms (LUTS), physical examination, uroflowmetry (Q-max and International Prostate Symptom Score) 3, 6, and 12 months of follow-up. ResultsA total of 30 patients underwent VOBMGU for bulbomembranous PTS were included. The median age of the patients was 63.5 (11.25). The median stricture length was 3.5 (1.5) cm. During follow-up, the mean Q-max significantly increased to 21.1 ± 5.5 ml/s (p < 0.0001), 20.1 ± 5.4 ml/s (p<0.001), and 19.1 ± 5.3 ml/s (p<0.003) at 3, 6, and 12 months respectively. IPSS significantly decreased to 8.93 ± 6.37 at the 12-month follow-up mark (p<0.0001). Three patients developed stricture recurrence and two patients developed post-operative urinary incontinence. ConclusionVOBMGU in cases of bulbomembranous urethral PTS offered excellent functional outcomes with low stricture recurrence and minimal risk of incontinence. Further prospective studies are warranted to confirm the results.

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.

A Comparative Study of the Outcome of Dorsolateral and Ventral Onlay Buccal Mucosal Graft Urethroplasty for Long Segment Bulbar Urethral Stricture

Background: Urethral strictures pose a significant challenge in urological practice, and substitution urethroplasty using a buccal mucosal graft is a widely accepted surgical technique. However, the optimal placement of the graft, whether dorsal onlay, ventral onlay or dorsolateral onlay is still unresolved. This study aimed to compare the outcomes of dorsolateral and ventral onlay buccal mucosal graft urethroplasty for long-segment bulbar urethral strictures. Methods: A prospective, quasi-experimental study was conducted at the Department of Urology, Dhaka Medical College Hospital, from July 2018 to September 2019. Fifty patients with long-segment bulbar urethral strictures were equally divided into two groups: Group-A (dorsolateral onlay) and Group B (ventral onlay). Patients were followed up for six months, and the groups were compared based on the International Prostate Symptom Score (IPSS), quality of life, maximum flow rate (Qmax), findings of retrograde urethrogram and voiding cystourethrogram, urethroscopic findings, complications and success rate. Results: Preoperative stricture lengths in Group-A and Group B were 3.62 ± 0.46 cm and 3.42 ± 0.54 cm respectively. Mean IPSS improved in both groups after surgery, with no significant difference between them. Mean Qmax also improved in both groups, with no significant difference between them. Success rates were 88% and 84% in Group-A and Group B respectively. Complications included wound hematoma, wound infection, and urethral diverticulum, while urethrocutaneous fistula and erectile dysfunction were not observed. Stricture recurrence rates were 12% in Group-A and 16% in Group B. Overall, both techniques demonstrated similar effectiveness and outcomes. Conclusion: Dorsolateral and ventral onlay buccal mucosal graft urethroplasty techniques yielded favourable short-term outcomes with low complication rates for long-segment bulbar urethral strictures. Both approaches were equally effective in terms of success ...

Ventral onlay buccal mucosa graft urethroplasty for female urethral stricture improves female sexual functions.

Female urethroplasty provides excellent results with high success rates in the treatment of female urethral stricture (FUS), but sexual functions after urethroplasty is another concern and have not been adequately investigated. We aimed to evaluate changes in the sexual functions of patients undergoing ventral onlay buccal mucosa graft urethroplasty (VOBMGU). We retrospectively evaluated 18 patients who underwent VOBMGU supported with a Martius labial fat pad flap (MLFPF) in our tertiary referral centre, between 2019 and 2021. After excluding patients who were sexually inactive and those with missing postoperative data, 13 patients were included. Surgical outcomes were assessed with uroflowmetry, the American Urological Association symptom score (AUA-SS), and Urogenital Distress Inventory (UDI)-6. Short Form-36 (SF-36) was used to evaluate the quality of life (QoL). Sexual function was assessed using the Female Sexual Function Index (FSFI) both preoperatively and at 6 months following surgery. The median age was 50 (IQR:44-62) years. There was no surgical failure, and none of the patients developed incontinence or stricture recurrence during a median follow-up of 30 (IQR:12-30) months. The median maximum flow rate increased from 9.2 (IQR:5-11.5) to 19 (IQR:17.35-27.10) ml/s (p = 0.001), the median post-void residual (PVR) volume decreased from 80 (IQR:0-205) to 20 (IQR:10-45) ml (p = 0.021), the median AUA-SS decreased from 19 (IQR:14-22) to 6 (IQR:4-8) (p = 0.001), and the median UDI-6 score decreased from 12 (IQR:6.5-16) to 4 (IQR:2-9) (p = 0.008) postoperatively. Bodily pain and general health perception domains and the physical component summary score were significantly improved in the SF-36 (p = 0.015, 0.022, and 0.009, respectively). The median total FSFI score increased from 17.40 (IQR:1.95-23.65) to 22.60 (IQR:5-24.95) postoperatively (p = 0.004). Improvements were observed in all domains (p < 0.05) except the arousal (p = 0.058) and pain (p = 0.104) domains of the FSFI. We concluded that VOBMGU has good early functional results and improves female sexual function.

41 - Ventral onlay buccal mucosa graft urethroplasty for female urethral stricture: Medium-term results in our referral center

41 - Ventral onlay buccal mucosa graft urethroplasty for female urethral stricture: Medium-term results in our referral center

MP74-01 CHARACTERISATION OF FEMALE URETHRAL STRICTURES

You have accessJournal of UrologyCME1 Apr 2023MP74-01 CHARACTERISATION OF FEMALE URETHRAL STRICTURES Elizabeth Day, Helena Gresty, Anthony Noah, Richard Nobrega, Jeremy Ockrim, and Tamsin Greenwell Elizabeth DayElizabeth Day More articles by this author , Helena GrestyHelena Gresty More articles by this author , Anthony NoahAnthony Noah More articles by this author , Richard NobregaRichard Nobrega More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , and Tamsin GreenwellTamsin Greenwell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female urethral stricture (FUS) is rare. We have assessed the history, imaging and urodynamic characteristics of all women seeking urethroplasty for recurrent symptomatic strictures. METHODS: A retrospective review of 63 consecutive women (median age 50.5 years, range 25-71) with recurrent or refractory FUS undergoing urethroplasty since June 2012. Data was analysed for symptom profile, aetiology and previous therapy. MRI, videourodynamic (VUDS) and examination findings provided stricture length and site. RESULTS: Median duration of symptoms was 60 months (range 24-456). The commonest symptoms were poor flow 61 (97%), frequency 48 (76%), nocturia 46 (73%), urgency 44 (70%), recurrent UTI 41 (65%) and urethral pain 40 (63%). The commonest causes of FUS are, unknown in 37 (59.7%), urethral instrumentation/catheterisation in 7 (11.1%), urethral diverticulum excision in 4 (6%), radiotherapy in 3 (4.7%), none relaxing sphincter in 3 (4.7%) and lichen planus in 2 (3.2%). The women had had a median of 5 previous urethral dilatations (range 0-33). 38 (60%) had been performing ISC for a mean of 24 months (range 6-120) and 31 (82%) found it painful. Pre-operative MRI pelvis was performed in 56 (89%) and revealed a concentrically thickened urethra in 35 (63%), urethral diverticulum in 4 (6%), an absent/fibrotic urethra in 4 (6%), and no abnormalities in 13 (21%). Pre-operative VUDS were performed in 57 (90%). Bladder outflow obstruction (BOO) was seen in 56 (98%). Preoperatively median Qmax was 5 mls/s (range 0-24), median Pdet Q max was 70 cm H2O (range 0-165) and median Solomon-Greenwell BOOIf was 51.4 (range -24.2-156.2) (where BOOIf >5 =>50% chance of BOO). Other findings included detrusor overactivity in 22 (39%) and stress urinary incontinence in 7 (12%).Median stricture length was 2.0 cm (range 0.5-4.0 cm) and the commonest sites were mid-distal in 20 (32%) and distal in 19 (30%). 53 (84%) had ventral onlay buccal mucosal graft urethroplasty, 6 (10%) had ventral vaginal flap urethroplasty, 2 (3%) had ventral onlay labial minora flap urethroplasty and 1 (1.5%) had a ventral vaginal graft urethroplasty – with stricture free status in 55 (87%) at last follow-up (median 39 months, range 4-112). CONCLUSIONS: Poor flow is present in almost all women with FUS. The majority will also have irritative LUTS, recurrent UTIs and urethral pain. VUDS and MRI are useful pre-operatively to characterise the stricture. Definitive treatment with urethroplasty should be considered earlier once endoscopic management has failed. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1069 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Day More articles by this author Helena Gresty More articles by this author Anthony Noah More articles by this author Richard Nobrega More articles by this author Jeremy Ockrim More articles by this author Tamsin Greenwell More articles by this author Expand All Advertisement PDF downloadLoading ...

MP60-16 DORSAL/ DORSO-LATERAL ONLAY BUCCAL MUCOSAL GRAFT VERSUS VENTRAL ONLAY LOCAL PENILE SKIN FLAP IN COMPLEX ANTERIOR URETHRAL STRICTURES; A PROSPECTIVE RANDOMIZED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP60-16 DORSAL/ DORSO-LATERAL ONLAY BUCCAL MUCOSAL GRAFT VERSUS VENTRAL ONLAY LOCAL PENILE SKIN FLAP IN COMPLEX ANTERIOR URETHRAL STRICTURES; A PROSPECTIVE RANDOMIZED STUDY Ahmed Tawakol, Mohammed Abdel-Rassoul, Mohamed Abdelwahab, Mohamed Elghoneimy, Ahmed Y. Abdelaziz, Ahmed Rammah, Mohamed Elgammal, and Amr Elkady Ahmed TawakolAhmed Tawakol More articles by this author , Mohammed Abdel-RassoulMohammed Abdel-Rassoul More articles by this author , Mohamed AbdelwahabMohamed Abdelwahab More articles by this author , Mohamed ElghoneimyMohamed Elghoneimy More articles by this author , Ahmed Y. AbdelazizAhmed Y. Abdelaziz More articles by this author , Ahmed RammahAhmed Rammah More articles by this author , Mohamed ElgammalMohamed Elgammal More articles by this author , and Amr ElkadyAmr Elkady More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003318.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Anterior urethral stricture is a challenging disease. Multiplicity of surgical techniques denotes that none is ideal. Our aim is to compare the use of buccal mucosal grafts (BG) versus local penile skin flaps (PF) in patients with complex anterior urethral strictures regarding success rates and complications. METHODS: A total of 34 adult patients with complex anterior urethral stricture were included. A complex anterior urethral stricture was defined as a stricture length of>2 cm and/or previous failed procedures, including urethral dilatation, internal optical urethrotomy and urethroplasty. We randomized patients to undergo either buccal mucosa dorsal/ dorso-lateral onlay graft or ventral onlay local penile skin flap urethroplasty. We compared operative time, estimated blood loss, complications, and succcess rates in both groups. Successful treatment outcome was defined as no further treatment of the urethral stricture required after urethroplasty and peak flow rate>15 ml/s. RESULTS: Mean follow up was 22.3 months in BG group vs 18.9 months in PF group. The site of the stricture, the median stricture length (40 mm in BG group Vs. 50 mm in PF group) and mean operative time were not statistically different between the two groups. Estimated blood loss was higher in PF group (median 400 ml and 300 ml in PF and BG group respectively, p=0.003); statistically significant but clinically insignificant.Two patients (11.8%) in each group developed wound infection. In PF group, one patient (5.9%) had urinary fistula, and one patient (5.9%) presented by mild ventral chordee post operatively. The success rates in the buccal mucosal and penile flap groups were similar (88.2%). CONCLUSIONS: Dorsal/ dorso-lateral onlay buccal mucosal graft and ventral onlay penile skin flap urethroplasty provided similar success rates. Complications were higher in the penile skin flap group. Both techniques can be used for the treatment of complex anterior urethral strictures with good outcome based on the surgeon's expertise. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e849 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Tawakol More articles by this author Mohammed Abdel-Rassoul More articles by this author Mohamed Abdelwahab More articles by this author Mohamed Elghoneimy More articles by this author Ahmed Y. Abdelaziz More articles by this author Ahmed Rammah More articles by this author Mohamed Elgammal More articles by this author Amr Elkady More articles by this author Expand All Advertisement PDF downloadLoading ...

Ventral and One-sided Dorsolateral Onlay Buccal Mucosa Graft Urethroplasty for Simultaneous Penile and Bulbar Urethral Stricture: A Case Report and Review of Literature

Ventral and One-sided Dorsolateral Onlay Buccal Mucosa Graft Urethroplasty for Simultaneous Penile and Bulbar Urethral Stricture: A Case Report and Review of Literature

Erectile and voiding function outcomes after buccal mucosa graft urethroplasty for long-segment bulbar urethral stricture: ventral versus dorsal onlay technique.

To compare the impact of dorsal versus ventral onlay buccal mucosa graft bulbar urethroplasty on postoperative erectile function status. We retrospectively reviewed the records for 232 patients who underwent dorsal and ventral onlay buccal mucosa graft bulbar urethroplasty from March 2012 to April 2021. Outcomes were urinary and erectile function status as assessed by IIEF5-15 score at preoperative, three months, and 12months post-urethroplasty. We compared the dorsal and ventral only techniques at the different follow-up visits using difference-in-differences analysis. 165 patients met our inclusion criteria; the overall success rate was 87.9% after a mean follow-up of 52.3 ± 18.5months. Of the patients, 17.6% experienced a 90-day complication. When comparing dorsal and ventral only techniques, there were no significant differences in terms of success rate (88.3% vs. 87.1%, Mantel-Cox test p = 0.68) or postoperative complications (15.5% Vs. 19.4%, p = 0.3). Likewise, there was no significant difference between both techniques regarding postoperative erectile function as assessed by IIEF5-15 score after three months (26.28 ± 2.53 Vs. 26.37 ± 2.41; p = 0.836) and twelve months (26.88 ± 2.45 Vs. 26.48 ± 1.98; p = 0.532). We detected a post-urethroplasty transient ED in (3.9% vs. 1.6%; p = 0.41), and permanent ED in (1.9% vs. 3.2%; p = 0.6) for dorsal and ventral onlay, respectively. Onlay Buccal mucosa graft urethroplasty is a highly effective surgery in treating long-segment bulbar urethral stricture. The dorsal and ventral only techniques were comparable regarding urinary and erectile function outcomes. Additionally, both techniques have no significant negative impact on post-urethroplasty erectile function status.

Optimizing decision-making after ventral onlay buccal mucosa graft urethroplasty failure.

To evaluate factors predicting recurrence after treatment and to assess the best rescue option for patients failing buccal mucosa graft (BMG) urethroplasty. We evaluated the data from 575 patients treated with ventral onlay BMG urethroplasty. Multivariable Cox regression analysis was performed to identify predictors of BMG urethroplasty failure, and their effect on failure risk was estimated using the Kaplan-Meier method and compared using log-rank tests. Then, for those patients who underwent a rescue treatment, namely, direct visual internal urethrotomy (DVIU) vs open urethroplasty, we assessed the probability of success after retreatment using the Kaplan-Meier method and regression tree analyses. On multivariable Cox regression analysis, only stricture length ≥5 cm (hazard ratio 3.46, 95% confidence interval 1.50-7.94; P = 0.003) was a predictor of failure. A total of 103 patients had at least one re-intervention. Notably, 12-month success rates after first rescue DVIU, second rescue DVIU, third rescue DVIU, and fourth rescue DVIU were 66.3%, 62.5%, 37.5% and 25%, respectively. Conversely, for those patients who underwent open urethroplasty retreatment, success rates at 12 months were 83.3%, 79%, 92.3% and 75% after BMG ventral onlay, first rescue DVIU, second rescue DVIU and third rescue DVIU, respectively. These data were confirmed in regression tree analyses. Ventral BMG urethroplasty fails in approximately one out of five patients. Despite DVIU as a rescue treatment being a good option, its success rate becomes lower as the number of DVIU treatments performed increases. Conversely, open urethroplasty improves patient outcomes in almost three out of four patients, even in the case of previous failed DVIU treatments for stricture recurrence.

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.

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 ...