Onlay Technique Research Articles

What Do We Know About the Chevrel Technique in Ventral Incisional Hernia Repair?

Introduction: In publications on ventral incisional hernia repair, the Chevrel technique and the onlay operation are often equated. This present review now aims to present the difference between these surgical techniques and analyze the findings available on the Chevrel technique.Materials and Methods: A systematic search of the available literature was performed in January 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, as well as a search of relevant journals, books, and reference lists. Thirty-four publications were identified as relevant for this review. For assessment of the Chevrel-technique with other surgical procedures there are no randomized controlled trials, prospective or retrospective comparative studies available but only case series. In the majority of case series the follow-up procedure is not reported.Results: In the onlay technique the defect is closed with direct suture or it is omitted altogether. Whereas, in the Chevrel technique this is done with sliding myofascial flaps harvested from the rectus sheaths. In the few case series available this appears to result in a lower recurrence rate for the Chevrel technique compared with the onlay technique. However, the rates of postoperative complications, surgical site occurrences (SSOs), surgical site infections (SSIs), seroma, and skin necrosis are as high as in the onlay technique. The reason for this is that both techniques require subcutaneous undermining with severance of perforator vessels.Conclusion: If mesh placement in onlay position has been chosen for specific reasons, preference can be given to the Chevrel technique over the standard onlay technique, although the study quality is limited.

Small and Laterally Placed Incisional Hernias Can be Safely Managed with an Onlay Repair

IntroductionIn meta-analyses and systematic reviews, clear advantages have been identified for the sublay versus onlay technique for treatment of incisional hernias. Nonetheless, an expert panel has noted that the onlay mesh location may be useful in certain settings.Materials and methodsFirst, unadjusted analysis of data from the Herniamed Registry was performed to compare 6797 sublay operations with 1024 onlay operations for repair of incisional hernias. Then, using propensity score matching to account for the influence of variables age, gender, ASA score, BMI, risk factors, preoperative pain, defect size, and defect localization, 1016 pairs were formed and compared with each other.ResultsUnadjusted analysis revealed that the onlay operation was used significantly more often for small defects, lateral defect localization, and in women. After comparing the propensity score-matched pairs, no significant difference was found between the sublay and onlay technique in the outcome criteria intra- and postoperative complications, general complications, complication-related reoperations, pain at rest, pain on exertion, chronic pain requiring treatment, and recurrence on 1-year follow-up. But that was true only for this carefully selected patient collective.ConclusionIn a selected patient collective with small and lateral incisional hernias and with a large proportion of women, outcomes obtained for the onlay and sublay techniques do not differ significantly.

Polypropylene mesh implantation for hernia repair causes myeloid cell-driven persistent inflammation.

Polypropylene meshes that are commonly used for inguinal hernia repair may trigger granulomatous foreign body reactions. Here, we show that asymptomatic patients display mesh-associated inflammatory granulomas long after surgery, which are dominated by monocyte-derived macrophages expressing high levels of inflammatory activation markers. In mice, mesh implantation by the onlay technique induced rapid and strong myeloid cell accumulation, without substantial attenuation for up to 90 days. Myeloid cells segregated into distinct macrophage subsets with separate spatial distribution, activation profiles, and functional properties, showing a stable inflammatory phenotype in the tissue surrounding the biomaterial and a mixed, wound-healing phenotype in the surrounding stromal tissue. Protein mass spectrometry confirmed the inflammatory nature of the foreign body reaction, as characterized by cytokines, complement activation, and matrix-modulating factors. Moreover, immunoglobulin deposition increased over time around the implant, arguing for humoral immune responses in association with the cell-driven inflammation. Intravital multiphoton microscopy revealed a high motility and continuous recruitment of myeloid cells, which is partly dependent on the chemokine receptor CCR2. CCR2-dependent macrophages are particular drivers of fibroblast proliferation. Thus, our work functionally characterizes myeloid cell-dependent inflammation following mesh implantation, thereby providing insights into the dynamics and mechanisms of foreign body reactions to implanted biomaterials.

Is there any superiority of the different abdominal closure techniques for primary closure in high-risk patients?

IntroductionIncisional hernia continues to be one of the major problems of surgery due to its high incidence rate and high morbidity. The aims of this study are to compare different repair techniques with primary repair techniques for the risk of incisional hernia.Material and methodsHigh-risk patients who had a midline incision of the abdomen were included in this study. Patients were divided into four groups. Each group contained 20 patients. Patients of group 1 were operated on using primary repair. In group 2 Cardiff repair technique was used. The patients in group 3 were repaired with Keel technique. The patients of group 4 were repaired with onlay technique. Patients were followed up with physical examination at 3-month periods in the first year after surgery and 6-month periods in the following two years. Incisional hernia, occurrence time and other complications were noted.ResultsEighty patients who had high risk of incisional hernia were included in this study. 47.5% of them were female and 52.5% of them were male. The average age of patients was 59.2 ±12.95. Average hospitalization time was 8.5 days (4–28 days). Average follow-up was 18 months (6–34 months). In total 4 (5%) patients had recurrence. Fifteen percent of patients in group 1 had recurrence and 5% of patients in group 2 had recurrence. There was no recurrence in other groups. There was no significant difference for incisional hernia and the other complications between groups (p = 0.368).ConclusionsThere was no significant difference between the techniques in terms of the development of incisional hernias or complications.

The use of self-gripping mesh with anterior component separation technique in incisional hernia repair: A case series

IntroductionIncisional hernia (IH) is a common postoperative complication that affects 10% of the patients who undergo abdominal surgery. The component separation (CS) technique is suitable for large and/or complex hernias; however, CS alone may not eliminate recurrence and is associated with an increased incidence of wound complications. Self-gripping mesh enhances tissue adhesion and contributes to a reduced risk of migration, chronic pain, and other complications. Here, we present three cases of IH that were successfully repaired by anterior CS (ACS) using onlay self-gripping meshes. Case presentationAll three patients underwent surgery using the following technique: Briefly, a skin flap was created with release of the external oblique muscle and preservation of the perforating vessels. The linea alba was closed with absorbable interrupted sutures. A self-gripping mesh was trimmed and placed with a 4–5 cm overlap bilaterally from the closed linea alba using an onlay technique. For all patients, the postoperative courses were uneventful and there were no complications at the 3-month follow-up. DiscussionThe advantages of our technique include more sufficient abdominal reinforcement, technical simplicity, and minimal time required for mesh placement. The disadvantages are the potential risk of decreased blood flow of the skin flaps, wound infection, intestinal fistula, persisting or chronic pain, and difficulty with subsequent abdominal surgery. ConclusionThe use of self-gripping mesh with ACS can be performed without increasing the operative time or causing short-term surgical complications. This technique may be recommended for large IH because of its simplicity and secure abdominal reinforcement provided.

The Effects of Operation Technique on Recurrence of Incisional Hernia Repair.

Objectives:The selection of incision type, closure type of incision and the suture material are some of the important factors to prevent hernia development. We should aim to perform the best procedure with the best technique to reduce the risk of recurrence. Surgical options include primary repair and open or laparoscopic repair with mesh. Mesh repairs can be performed as onlay, sublay or inlay according to the area where the mesh is to be laid. In this retrospective study, our main goal was to compare the recurrence rates in patients who underwent incisional hernia repair with onlay and inlay mesh techniques.Methods:This retrospective study included 185 patients who underwent surgery due to incisional hernia in our clinic between January 2012 and October 2017. Patients were divided into two groups according to the technique as Group 1 with onlay mesh repair and Group 2 with inlay mesh repair. The same type of mesh (prolen) was applied to all patients.Results:There were 121 patients in Group 1 and 64 patients in Group 2. According to data we obtained, 64.3% of the patients were women and the mean age of all patients was 58.4±16.4 years. Postoperative complications (such as seroma-hematoma, surgical site infection, mesh rejection, postoperative ileus) developed in 29.2% (n=54) of the patients. The length of hospital stay was 4.2±3 days in Group 1 and 5.6±5 days in Group 2. The mean follow-up period was 48.6 months (24-93 months), with the recurrence rates of 5.8% (n=7) in Group 1 and 10.9% (n=7) in Group 2, respectively. There was a statistically significant difference between the groups concerning comorbidity, postoperative complications, the length of hospitalization stay and recurrence.Conclusion:We believe that the onlay technique will be more appropriate than the inlay technique when only prolen mesh is preferred because the recurrence rates are higher in the inlay technique.

Intraperitoneal alloplasty combined with the anterior separation technique in giant incisional hernias.

to improve the results of surgical treatment of giant IH using ACST + IPOM. Analysis of surgical treatment of 164 patients with giant IH aged 30 to 75 (mean age 54.7 ± 3.3). Depending on the surgery, the patients were divided into two groups. Group I (82 patients) consisted of patients who underwent our modified technique, including ACST + IPOM. The surgery in group II (82 patients) involved ACST + onlay. As compared with ACST + onlay, ACST + IPOM surgery contributes to a significantly reduced incidence of ACS [6.1% (group II) versus 0 (group I), (p <0.05)], seroma [25.6% versus 7.3%, p <0.05], surgical site infection (SSI) [4.9% versus 2.4%, p> 0.05], meshoma [3.7% versus 0] and hernia recurrences [6.5% versus 1.6%, p> 0.05]. IAP value equal or exceeding 9.1 mmHg (1.2 kPa) during surgery in approximated rectus muscles is prognostic for ACS occurrence and requires intraoperative preventive measures. Utilization of ACST + IPOM in giant IH ensures an optimal abdominal cavity volume without a substantial increase in IAP and reduces the probability of ACS, whereas the use of ACST + onlay results in ACN in 6.1% (p <0.05) patients. Reduced contact of the mesh with the subcutaneous tissue in ACST + IPOM contributes to a significantly lower incidence of seroma [7.3% vs 25.6% (p <0.05)], surgical site infection (SSI) [2.4% vs 4.9% (p> 0.05)], postoperative wound infiltrate [2 (2.4%) vs. 11 (13.4%) (p <0.05)], chronic postsurgical pain [1 (1.6%) vs. 5 (8.1%) (p> 0.05)] and recurrent IH [1 (1.6%) vs. 4 (6.5%) (p> 0.05)] as compared with ACST + onlay technique.

Long head of biceps tenodesis at the superior aspect of the biceps groove: A biomechanical comparison of inlay and onlay techniques.

Pathology involving the long head of the biceps tendon is a common source of shoulder pain. Biceps tenodesis has been successfully used in areas below the pectoralis, above the pectoralis, and above the biceps groove. However, clinical data are lacking for additional techniques for tenodesis at the superior aspect of the biceps groove. A biomechanical comparison was completed examining six matched pairs of cadaveric shoulders. The ultimate load to failure was compared between an inlay and onlay biceps tenodesis at the superior aspect of the biceps groove. The results demonstrate an average construct strength of 215 N for the inlay technique and 210 N for the onlay technique. The difference between the two techniques was not significant. This study demonstrates similar biomechanical strength for both constructs.

Onlay Technique in Incisional Hernia Repair-A Systematic Review.

Introduction: A meta-analysis that compared the onlay vs. sublay technique in open incisional hernia repair identified better outcomes for the sublay operation. Nonetheless, an Expert Consensus Guided by Systematic Review found the onlay mesh location useful in certain settings. Therefore, all studies on the onlay technique were once again collated and analyzed.Materials and Methods: A systematic search of the available literature was performed in August 2018 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library. For the present analysis 42 publications were identified as relevant.Results: In five prospective randomized trials and 17 observational studies the postoperative complication rates ranged between 5 and 76%, with a mean value of 33.5%. The recurrence rates in these studies also ranged between 0 and 32%, with a mean value of 9.9%. Hence, compared with the literature data on the sublay operation, more post-operative complications, in particular wound complications and seroma, with a comparable recurrence rate, were identified.Conclusion: When the onlay technique is used in certain settings for incisional hernia repair, a careful dissection technique and prophylactic measures (drainage, abdominal binders, fibrin sealant) should be employed to prevent wound complications and seroma formation.

Patella alta and patellar subluxation might lead to early failure with inlay patello-femoral joint arthroplasty.

With the growing interest in resurfacing procedures, several new implants have been recently introduced for isolated patello-femoral joint arthroplasty (PFA). However, not much data are available for these new techniques or about the right indications for each type of implant. Out of a retrospective cohort of 20 inlay PFA, 11 PFA with an elevated Insall-Salvati index and an increased patello-femoral congruence angle showed an initial satisfactory result, but presented thereafter with recurrent pain and "clunk" phenomena. They were all revised after a median time of 25months (range 8-28months) into an onlay technique PFA and analyzed for their failure mode and revision technique. Clinical symptoms such as clunking, as well as abraded areas craniolateral of the inlay implant found intraoperatively, were the main observations of this study. The modified Insall-Salvati index (mISI) was significantly higher in the revised knees compared to the unrevised (median 1.8 versus 1.6; p = 0.041). VAS and KSS significantly improved after revision (median VAS reduction in pain of 4.0 points, median KSS improvement of 20.0 points; p < 0.05). Patients with high-normal patellar height index or patella alta, as well as a craniolateral type of arthritis with additional lateralization, should be considered contra-indicated for an inlay technique PFA. They could be considered for a PFA system reaching further proximal into the distal femur. An onlay PFA can be an option for early revision of failed inlay implants. The clinical relevance of this study is that patella alta and patellar subluxation are more difficult to adjust for with an inlay PFJ component. Level IV.

Factors Indicative of Recurrence Paraumbilical Hernia: Experience at a Tertiary Care Hospital in Dhaka City

Background: Paraumbilical hernia has gained little attention from surgeons in comparison with other types of abdominal wall hernias (inguinal, postoperative); however, the primary suture for paraumbilical hernia is associated with a recurrence rate of 19.0 to 54.0%.Objective: The aim of this study was to analyze the results of the paraumbilical hernia repair and to assess the independent risk factors influencing paraumbilical hernia recurrence.Methodology: A retrospective analysis of patients who underwent surgery for paraumbilical hernia in the department of surgery, Dhaka Medical College Hospital from 2012 to 2015 was performed. Age, sex, hospital stay, hernia size, patient’s body mass index, and postoperative complications were analyzed. Postoperative evaluation included pain and discomfort in the abdomen and hernia recurrence rate. Hernia recurrence was diagnosed during the patients’ visit to a surgeon. Two surgical methods were used to repair paraumbilical hernia: open suture repair technique (keel technique) and open mesh repair technique (onlay technique). Every operation was chosen individually by the surgeon.Results: Ninety-seven patients (31 males and 66 females) with paraumbilical hernia were examined. The rate of postoperative complications was 5.2%. The complete patient’s recovery time after surgery was 2.4±3.4 months. Fourteen patients (20.9%) complained of pain or discomfort in the abdomen, and 7(10.4%) patients had ligature fistula after the surgery. Forty-five patients (67.2%) did not have any complaints after surgery. The recurrence rate after paraumbilical hernia repair was 8.9%. The recurrence rate was higher when hernia size was &gt;2cm (9% for &lt;2 cm vs 10.5% for &gt;2 cm) and patient’s BMI was &gt;30 kg/m2 (8.6% for &lt;30 vs 10.7% for &gt;30).Conclusion: In conclusion significant independent risk factors are found for paraumbilical hernia recurrence.Journal of Current and Advance Medical Research 2018;5(1):11-14

V29 - Urethral reconstruction using tissue-engineered oral mucosa graft MukoCell® in onlay technique

V29 - Urethral reconstruction using tissue-engineered oral mucosa graft MukoCell® in onlay technique

Open mesh repair, is still a standard technique for incisional hernia: a comparision study between sublay and onlay technique in the era of laparoscopy

Background: Incisional hernia (IH) remains a very frequent postoperative complication and common hernias in middle aged population more commonly in females. The two techniques most frequently used are the onlay repair and sublay repair. Various studies have been conducted to compare the advantages and disadvantages of sublay and onlay mesh repair in incisional hernia and the superiority of sublay mesh repair. These studies whether they hold good for the population is a pertinent question. In view of this, author need to study the appropriate surgical techniques sublay versus onlay repair in the set up.Methods: Author conducted randomized comparative study of 100 patients having incisional hernia admitted to various surgical units of SNMC and HSK Hospital, Bagalkot during the period December 2014 to June 2016.Results: In present study of 100 cases, females have more incidence of incisional hernias than males. In onlay technique seroma formation was found in 72% of patients postoperatively and 4% in sublay technique. Surgical site infection (SSIN) was noticed in 8% of sublay technique whereas 12% in onlay technique. There is no recurrence in sublay group whereas onlay had 12% recurrence.Conclusions: Sublay technique is superior to onlay concerning the hospital stay, complications and recurrence.

Long-term follow-up (at 5years) of midline incisional hernia repairs using a primary closure and prosthetic onlay technique: recurrence and quality of life.

The recurrence rate of incisional hernia (IH) repair is usually underestimated due to a lack of long-term follow-up. The objective of this study was to evaluate recurrence rate for patients operated on midline IH surgery, using a primary closure and prosthetic onlay technique, 5years after the procedure. From January 2009 to January 2011, all 92 patients operated on elective midline IH repair by primary closure and prosthetic onlay technique in a General Surgery Department were retrospectively included in the study. Exclusion criteria were absence of follow-up or death. Recurrence rate and quality of life were assessed. Demographic, surgical data and quality of life in patients with and without 5-year recurrence were compared. Mean follow-up was 64months. Ultimately, 76 patients were included in the study, representing 82% of the selected patients during the study period (76/92), of whom 24 presented a recurrence (32%). Half (12) were diagnosed for recurrence more than 3years after the surgery. Patients who developed a recurrence had more percentage of obesity (64 vs. 29%, p=0.016), which denoted an odds ratio (OR) for recurrence of 4.4 (1.2-15.7; p=0.01) and they punctuated lower in quality of life (6.0±2.9 vs. 7.6±2.6, p=0.006). Recurrence rate on midline IH repair is still a concern (32% at 5years). It is advisable to look for other strategies and more efficient surgical techniques for IH surgery, especially in obese patients.

Repair of large incisional hernias with onlay mesh

Background Any surgical incision can lead to the occurrence of incisional hernia (IH) even laparoscopic trocar incision. IHs typically develop within the first 5 years of surgery; however, their development may be delayed. In large hernias, the amount of viscera which progressively stretches and holds the hernia sac can form a 'second abdomen' making the repair of hernia difficult. Aim IH after abdominal surgery is an important problem. We aimed to evaluate the short-term recurrence rate as well as surgical complications in patients operated with onlay mesh repair technique for large and giant IHs. Patient and methods In our study, we had 40 patients who were complaining of large IH with a defect size of 10 cm or more. All of these patients were operated using the onlay mesh technique in which polypropylene mesh was used. Results A total of 40 cases of IH were repaired with placement of onlay mesh; two (5%) cases developed recurrence. The incidence of seroma in our study was 22.5%, making it the most common complication following the repair of IH. Seroma formation was followed by surgical site infection (15%) as the second most common complication. Conclusion Repair of large and giant IH using prosthetic nonabsorbable mesh has a reasonably good outcome with acceptable rates of recurrence. The technique of mesh placement is still at the surgeon's discretion. However, onlay mesh repair has shown promising results in our study. Seroma is the most common complication following the repair of large and giant IHs.

Is circumferential urethral mobilisation an overdo? A prospective outcome analysis of dorsal onlay and dorso - lateral onlay BMGU for anterior urethral strictures.

ABSTRACTIntroductionFor dorsal onlay graft placement, unilateral urethral mobilization is less invasive than standard circumferential urethral mobilization. Apart from success in terms of patency of urethra, other issues like sexual function, overall quality of life and patient satisfaction remain important issues while comparing outcomes of urethroplasty.AimTo prospectively compare the objective as well as subjective outcomes of two approaches.Materials and MethodsBetween July 2011 and January 2015, 136 adult males having anterior urethral stricture with urethral lumen ≥ 6 Fr. were prospectively assigned between two groups by alternate randomization. Operative time, complications, success rate (no obstructive symptoms, no need of any postoperative intervention, Q max > 15mL/sec), sexual functions (using Brief Male Sexual Function Inventory) were compared.ResultsBaseline parameters were similar in both groups (68 in each group). Overall success rate was similar in both groups (89 % and 91 % respectively). Improvement in total LUTS scores was similar in groups. Changes in overall health status (VAS and EQ 5D) was equal in both groups. Erectile function score was significantly decreased in DO than DL group while ejaculatory function and sexual desire remained stable after urethroplasty in both groups.ConclusionsIn anterior urethral stricture buccal mucosa graft provides satisfactory results as onlay technique. No technique whether dorsolateral and dorsal techniques is superior to other. Dorsolateral technique needs minimal urethral mobilization and should be preferred whenever feasible.

Repair of panurethral stricture: Proximal ventral and distal dorsal onlay technique of buccal mucosal graft urethroplasty

ObjectiveTo report the surgical details and results of our technique of buccal mucosal graft (BMG) urethroplasty for panurethral stricture, as many studies have reported repair of panurethral stricture by single-stage BMG urethroplasty by placing buccal mucosa ventrally, dorsally or dorsolaterally. Patients and methodsThis was an observational analysis of 38 patients with panurethral stricture treated by placing two BMGs, one as a ventral onlay in the proximal bulbar urethra and the other as a dorsal onlay in the distal bulbar and penile urethra. Success was defined as asymptomatic state with or without need for a postoperative single intervention such as dilatation or internal urethrotomy. ResultsThe 38 patients had a mean age of 44 years, with lichen sclerosus as the predominant cause of stricture. The ultimate success rate was 84.2% at the end of 3 months and 89.5% at the end of 1 year. Recurrent strictures appeared only in the failed cases during the follow-up period of 11 months. None of the patients needed redo urethroplasty during the follow-up period. ConclusionsA proximal ventral and distal dorsal onlay technique of BMG urethroplasty is an available alternative for repairing panurethral stricture. The technique described is simple and easily reproducible with encouraging results compared to other similar techniques.

Robotic Ureteral Reconstruction Using Buccal Mucosa Grafts: A Multi-institutional Experience

BackgroundMinimally invasive treatment of long, multifocal ureteral strictures or failed pyeloplasty is challenging. Robot-assisted buccal mucosa graft ureteroplasty (RBU) is a technique for ureteral reconstruction that avoids the morbidity of bowel interposition or autotransplantation. ObjectiveTo evaluate outcomes for RBU in a multi-institutional cohort of patients treated for revision ureteropelvic junction obstruction and long or multifocal ureteral stricture at three tertiary referral centers. Design, setting, and participantsThis retrospective study involved data for 19 patients treated with RBU at three high-volume centers between October 2013 and July 2016. Surgical procedureRBU was performed using either an onlay graft after incising the stricture or an augmented anastomotic repair in which the ureter was transected and re-anastomosed primarily on one side, and a graft was placed on the other side. Outcome measurements and statistical analysisPreoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. Results and limitationsThe onlay technique was used for 79%, while repair was carried out using the augmented anastomotic technique for the remaining cases. The reconstruction was reinforced with omentum in 95% of cases. The ureteral stricture location was proximal in 74% and mid in 26% of cases. A prior failed ureteral reconstruction was present in 53% of patients. The median stricture length was 4.0cm (range 2.0–8.0), operative time was 200min (range 136–397), estimated blood loss was 95ml (range 25–420), and length of stay was 2 d (range 1–15). There were no intraoperative complications. At median follow-up of 26 mo, the overall success rate was 90%. ConclusionsRBU is a feasible and effective technique for managing complex proximal and mid ureteral strictures. Patient summaryWe studied robotic surgery for long ureteral strictures using grafts at three referral centers. Our results demonstrate that robotic buccal mucosa graft ureteroplasty is a feasible and effective technique for ureteral reconstruction.

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

Clinical and Patient-reported Outcomes of 1-sided Anterior Urethroplasty for Long-segment or Panurethral Strictures

To evaluate clinical and patient-reported urinary and sexual outcomes after a long-segment stricture repair using the 1-sided urethral dissection, penile invagination, and dorsal buccal mucosa graft onlay technique described by Kulkarni etal. Patients from 4 institutions after single-stage repairs for long-segment urethral strictures (>8 cm) from January 2002 to April 2016 were reviewed. Technique described by Kulkarni etal was used in all cases. Clinical outcomes included uroflowmetry (Qmax) and post-void residuals. Patient-reported outcome measures included International Prostate Symptom Score survey, Sexual Health Inventory for Men, Male Sexual Health Questionnaire, and Global Response Assessment questionnaire to measure voiding, sexual, ejaculatory symptoms, and overall improvement, respectively. Seventy-three patients with a minimum of 12 months' follow-up were included. The mean age and stricture length were 56 (21-80) years and 13.6 (8-21) cm, respectively. At a mean follow-up of 44 (12-162) months, 9 of 73 (12%) strictures recurred. The mean baseline International Prostate Symptom Score of 23 (7-24) decreased to 10 (1-17) on follow-up (P <.001). Eight of 42 patients (21.4%) reported an increase, and 6 of 42 patients (14.3%) decreased in Sexual Health Inventory for Men following urethroplasty. Ejaculatory function on Male Sexual Health Questionnaire improved after urethroplasty from 8 preoperatively to 11 postoperatively (P <.004). All patients reported improvement after urethroplasty on Global Response Assessment questionnaire. Post-void dribbling and chordee occurred in 45% and 25% of patients, respectively. Durable patency in most patients is demonstrated in this study. PROMs indicate an improvement in urinary function and moderate effect on sexual function. Transient penile chordee was evident in 25% of patients.