Onlay Buccal Mucosal Graft Urethroplasty Research Articles

7 MIDTERM OUTCOME OF COMBINED DORSAL PLUS VENTRAL DOUBLE BUCCAL MUCOSA GRAFT IN LONG ANTERIOR URETHRAL STRICTURE

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery1 Apr 20117 MIDTERM OUTCOME OF COMBINED DORSAL PLUS VENTRAL DOUBLE BUCCAL MUCOSA GRAFT IN LONG ANTERIOR URETHRAL STRICTURE Samir Elgamal, Mohamed Abo El-Enen, Mohamed Radwan, and Tarek Gamel Samir ElgamalSamir Elgamal Tanta, Egypt More articles by this author , Mohamed Abo El-EnenMohamed Abo El-Enen Tanta, Egypt More articles by this author , Mohamed RadwanMohamed Radwan Tanta, Egypt More articles by this author , and Tarek GamelTarek Gamel Tanta, Egypt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.068AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Buccal mucosal graft (BMG) substitution urethroplasty has become the most widespread method of anterior urethral stricture repair with good results.The aim of this study is to report the medium-term results of repairing long anterior urethral strictures with combined dorsal inlay plus ventral onlay buccal mucosal grafts. METHODS Between March 2007 and January 2009, 21 patients, mean age 37.3 years, with long anterior urethral strictures underwent combined dorsal inlay plus ventral onlay buccal mucosal graft urethroplasty. The strictured urethral segment was opened along its ventral surface; the exposed dorsal urethra was incised in the midline to create an elliptical area over the tunica albuginea where the dorsal inlay BMG was placed. Subsequently, the ventral onlay BMG was sutured to the urethral lateral margins to complete the urethroplasty. The follow-up included uroflowmetry with an ultrasound to estimate the residual urine volume at 3 months,6 months, 1 year and yearly thereafter, or at the onset of obstructive voiding symptoms. A retrograde urethrogram with a voiding cysto-urethrogram was taken at 3 and 6 months. A successful outcome was defined as normal voiding with no stricture on the voiding cysto-urethrogram and no need for subsequent instrumentation. RESULTS The mean (range) age of the patients was 37.3 (21–62) years. The mean preoperative maximum flow rate was 7.8 mL/s with a mean residual volume of 82.7 mL. . The mean operative duration was 124 min, and the stricture length 3.3 cm. The mean dorsal and ventral buccal mucosa graft length were, respectively, 2.8 and 5.3 cm. Follow-up was available in 19 patients (90.5%) with a mean of 23 months. The overall success rate was 89.5 %. Both failures occurred within the first year and were managed successfully by internal urethrotomy. There were no medium-term donor-site complications. Postmicturition dribbling of urine was noted in 4 patients (21%). CONCLUSIONS Combined double buccal mucosa graft is performed through ventral sagittal urethrotomy approach which is easier than the dorsal urethrotomy approach and has good results especially in patients with tight strictures with very narrow and scarred urethral plate as it provides wider neourethra than a single patch graft substitution. Our medium-term results are very encouraging. However, long-term results and more randomized studies are needed to establish this technique as a procedure of choice in future. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e3 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samir Elgamal Tanta, Egypt More articles by this author Mohamed Abo El-Enen Tanta, Egypt More articles by this author Mohamed Radwan Tanta, Egypt More articles by this author Tarek Gamel Tanta, Egypt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urethral fistula following circumcision: salvaged by buccal mucosa graft urethroplasty

Fistula following circumcision and at times accompanied by disfigurement of the glans penis is a common problem in our country, where a large number of circumcision is performed by untrained professionals. These complications may have profound negative psychological impact on the growing child. Herein, we report the successful closure of such fistula using buccal mucosa, which occurred following circumcision (for phimosis) in a 15 year old boy. This resulted in the disfigurement of the glans penis with a distal urethral fistula. The fistula was managed by dorsal onlay buccal mucosa graft urethroplasty (BMGU). The patient has excellent cosmesis at 6 months followup with a good urinary stream. This technique can give better results than those, where skin grafts or local flaps are used for fistula closure. BMGU is a versatile technique with good long term results. The cosmesis and functional results are satisfactory and help in improving the self esteem and sexual function in the years to come.

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

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

VID-06.04: Ventral bulbar augmentation [VBA]: a technique to enhance support of buccal mucosal graft placed ventrally for proximal bulbar urethral strictures

Higher complication rate with ventral onlay buccal mucosal graft urethroplasty (BMGU) as compared to dorsal placement of the mucosal graft has been largely attributed to poor ventral support for the graft. We herein describe a technique to refashion and augment the thickness of that portion of the bulb that forms the base of the ventral graft in an attempt to decrease this complication rate.

Reconstruction of the bulbar urethra using dorsal onlay buccal mucosal grafts: New concepts and surgical tricks

Buccal mucosa onlay graft urethroplasty represents one of the most widespread methods for the repair of strictures in the bulbar urethra, because of its thick and highly vascular spongiosum tissue. Recently the location of the patch has become a contentious issue, since we described our original techniques of dorsal onlay graft urethroplasty. The design rationale for this approach was based on the concept that the corporeal body remains a healthy host for receiving a free transplanted tissues. Moreover, graft fixation onto a defined surface may decrease graft shrinkage and sacculation. The success rate using buccal mucosa grafts for the repair of bulbar urethral strictures has generally been high with dorsal or ventral onlay grafts or using an augmented roof-strip anastomotic urethroplasty. We describe here the fundamental concepts of the bulbar urethra reconstruction using buccal mucosal grafts, presenting a new surgical technique of dorsal onlay buccal mucosa graft urethroplasty using fibrin glue.

Minimal impact urethroplasty allows same-day surgery in most patients

Objectives To present our evaluation of the safety and feasibility of decreasing the impact of anterior urethroplasty by minimizing the surgery time, maximizing adjuvant pain therapy, and using anesthetic agents that decrease the incidence and severity of side effects, which allows most patients to leave the hospital comfortably within 4 hours of surgery. Methods A retrospective chart review of 54 consecutive anterior urethroplasty patients from August 2000 to August 2004 (34 anterior anastomotic and 20 ventral onlay buccal mucosal graft urethroplasty) was performed. Results Historically, 27% of patients had undergone same-day surgery (SDS). After the initiation of minimal impact surgery and early discharge, 85% did so. All but one admission was planned (1 patient [2%] had hypotension in the recovery room and was admitted). No postoperative readmissions or emergency room visits occurred. The admitted patients had comparable stricture length to, but slightly older age (49 years compared with 42 years) than, the SDS patients. The perioperative complications were mild (small wound gap, small scrotal hematoma) and were seen in 5% of SDS patients and 0% of admitted patients. Late complications (chordee, mild erectile dysfunction, and urinary tract infection) were seen in 19% of SDS patients and 18% of admitted patients. The incidence of recurrences after a mean follow-up of 27 months was comparable (3% for the SDS and 6% for the admitted group). Conclusions Decreasing the impact of urethroplasty surgery allows safe early discharge for most patients. Unexpected admissions were uncommon, and we continue to plan for admission only for the extremely elderly, those with severe comorbidities, and those expected to undergo lengthy (longer than 5 hours) surgery.

Anastomotic Urethroplasty For Bulbar Urethral Stricture: Analysis Of 168 Patients

We reviewed our experience with anastomotic urethroplasty for anterior urethral stricture. A chart review revealed 168 patients 6 to 82 years old (mean age 38) with at least 6 months of followup (mean 70, range 6 to 291) after anastomotic urethroplasty. Average stricture length was 1.7 cm. Of the 168 patients stricture recurred in 8 (5%) but was managed by direct vision internal urethrotomy or a single dilation in 5, while repeat urethroplasty was required in 3 (2%). In these 3 cases extenuating circumstances included patient dislodgment of the catheter with attempts to replace it that disrupted repair, a history of urethrocutaneous fistula and periurethral abscess, and previous irradiation complicating the stricture in 1 each. Other complications were uncommon, such as transient thigh pain or numbness in 3 patients (2%), small wound dehiscence in 2 (1%), and scrotal hematoma, erectile dysfunction and self-limited pulmonary edema in 1 (less than 1%) each. Anastomotic urethroplasty for anterior stricture has a high success rate of 95%. It is technically straightforward and complications are uncommon. Cure by anastomotic urethroplasty should be strongly favored over long-term management by direct vision internal urethrotomy or dilation.