Reconstruction Of Urethral Strictures Research Articles

Evaluation of bi-layer silk fibroin grafts for onlay urethroplasty in a rabbit model of urethral stricture disease.

Background: Autologous tissues such as buccal mucosa (BM) are widely used for reconstruction of urethral strictures; however, limitations such as donor site morbidity and scarce tissue supply require the development of alternative biomaterials for urethral repair. The goals of this study were to determine the safety and efficacy of bi-layer silk fibroin (BLSF) matrices for urethral stricture repair and compare histological and functional outcomes to the standard approach, BM urethroplasty under good laboratory practices.Material and methods: A total of 13 rabbits exhibiting urethral stricture formation following electrocoagulation injury were treated with onlay urethroplasty with either acellular BLSF (N=7) or autologous BM (N=6) grafts for 3months. Uninjured control rabbits were maintained in parallel (N=4).Results and conclusion: Animals receiving BLSF implants were demonstrated to be functionally equivalent to BM grafts in their ability to restored strictured calibers, support micturition and promote tissue regeneration with minimal inflammation.

Transperineal anastomotic posterior urethroplasty with bulbocavernosus flap and fibrin sealant in the complicated posterior urethral stricture reconstruction: a retrospective cohort study.

Management of complicated posterior urethral stricture is challenging. Modified transperineal anastomotic urethroplasty (TAU) with bulbocavernosus flap interposition and human fibrin sealant provides another treatment option. The authors aimed to evaluate whether this technique could improve the success rate in the complicated posterior urethral stricture reconstruction in this study. Between 2016 and 2019, 48 patients underwent either conventional or modified TAU. The criteria for success included both the absence of clinical symptoms and no need for further surgical intervention during follow-up. Twelve patients underwent the modified TAU (group A) using bulbocavernosus flap interposition and human fibrin sealant. Thirty-six patients underwent the traditional end-to-end anastomotic urethroplasty (group B). Follow-up was 24.3-57.2 months. The patients in group A had a higher surgery success rate compared to the patients in group B (91.7 vs. 63.9%, P =0.067), with a quasi-significant result. Besides, no postoperative complications were observed in group A, while two individuals in group B had urinary incontinence, but the difference was not significant (0 vs. 5.6%, P =0.404). Based on the preliminary results, modified TAU with bulbocavernosus flap interposition and human fibrin sealant is a safe and feasible technique for complicated posterior urethral stricture reconstruction.

Dorsal oral mucosa graft urethroplasty for female urethral stricture reconstruction: A narrative review.

Female urethral stricture is currently a challenging situation. In general, urethra dilatation can be selected for treatment, but the complications and high recurrence rate urge doctors to consider other treatments. Recently, dorsal oral mucosa graft urethroplasty is concerned by more and more surgeons, but there are not enough reports so far. A comprehensive search of dorsal oral mucosa graft urethroplasty was performed. According to the existing literature, there are applications of buccal mucosa and lingual mucosa, and compared with other kinds of grafts, the success rate is higher. However, there is a lack of multicenter, large sample and long follow-up studies. And there is still no enough comparative study between different types of oral mucosa. In summary, dorsal oral mucosa graft urethroplasty is an effective option for the management of female urethral stricture. More multicenter and large sample studies with long-term follow-up data are needed.

Многоэтапные операции при стриктурах передней уретры: оценка сексуальной функции.

Introduction. Any sexual dysfunction or complications associated with urethral stricture reconstruction can negatively affect quality of life and patient satisfaction with treatment results, even if the operation is considered 'successful' and urethral patency is restored. According to the literature data, the frequency of erectile dysfunction detected after urethroplasty varies from 0 to 40%. However, most publications are focused on the study of sexual disorders caused bulbar urethral reconstruction and one-stage surgical techniques. Purpose of the study. To evaluate sexual function in patients undergoing multi-stage urethroplasty. Materials and methods. The study included 73 men aged 18–84 years who underwent multi-stage urethroplasty for the anterior urethral structures in 2010–2019. Penile strictures were present in 39 (53.4%) patients, bulbar strictures in 7 (9.6%), penile bulbar strictures in 15 (20.5%) and multifocal strictures in 12 (16.4%) cases. The length of the strictures was 7.27 ± 3.26 (2–18) cm. The effect of staged urethral surgery on sexual function was studied using the IIEF-5, MSHQ-EjD, and MSHQ-InS questionnaires. The mean time from surgery to evaluation of sexual function was 67.8 ± 32.3 (14–134) months. Wilcoxon signed rank test, Mann-Whitney U test, and Kruskal-Wallis H test were used to test for differences in preoperative and postoperative values. Differences were considered significant at p < 0.05. Results. There were no significant changes in the initial indicators of the IIEF-5 questionnaire compared to the postoperative ones (19.67 ± 3.45 (5 – 25) vs 21.73 ± 2.47 (6 – 24) points; the mean difference was (Δ) 2.1, 95% confidence interval (95% CI) 16.1 – 20.2, p = 0.468). The total score of the MSHQ-EjD questionnaire increased from 14.67 ± 3.33 (1 – 28) to 25.41 ± 5.65 (1 – 34) points, the mean difference (Δ) was 10.8, 95% confidence interval (95% CI) – 15.4 – 18.9 (p < 0.001). Similar improvements were observed in the analysis of preoperative and postoperative scores of the MSHQ-InS questionnaire (17.31 ± 4.67 (5 – 30) vs. 24.61 ± 4.13 (8 – 30) points; Δ = 7.2; 95% CI: 15.4 – 18.8, p = 0.036). Conclusions. Patients who underwent multi-stage urethroplasty have minimal changes in erectile function and significant improvements in ejaculatory function, as well as the expressiveness of sexual satisfaction.

Outcome of dorsal buccal graft urethroplasty in female urethral stricture disease (FUSD); our institutional experience.

Female urethral stricture is a poorly studied disease entity. To date, its management has been poorly evaluated, with small numbers and various definitions of success. Treatment options traditionally have been urethral dilatation and/or self-catheterization with success rates ranging from only 14 to 49%. However, there has been increasing use of urethroplasty due to the improved success rate (70 to 100%). In this study we assessed the outcome of dorsal buccal mucosal grafts in female urethral stricture disease. In our study we prospectively analyzed 25 female patients treated from 2014 to 2019 at our institute; ages ranged from 26 to 66years. Dorsal buccal mucosal graft urethroplasty was performed in all patients. The pathology of female urethral stricture disease is unknown, and neither the pre- nor the intraoperative assessment allows determining the precise location and extent or the severity of urethral damage; therefore, we advocate extensive grafting of the entire urethra. Patients were followed every 3 months during the 1st year and then biannually with lower urinary tract symptom, uroflowmetry and post-void residual urine assessments. Stricture recurrence (failure) was defined as recurrence of symptoms, no change or reversal in Qmax and post-void residual urine values and failure of negotiation of a 17-Fr cystoscope. Success rate of our surgical intervention was > 90%. We observed that the mid-urethra was the most common location of the stricture. Stricture location was confined to the distal urethra in 12%, the mid-urethra in 16%, spanned the distal mid-urethra in 16%, spanned the mid-proximal urethra in 40% and spanned the pan-urethra in 16%. Mean stricture length was 1.8 (0.7-2.1)cm. Mean pre- versus postoperative Qmax was 5ml/s versus 23.3ml/s and mean residual urine was 178ml versus 18.5ml. Two patients had stricture recurrence at 3months post-intervention. Dorsal buccal mucosal graft currently represents a prime choice for female urethral stricture reconstruction, keeping in view the advantages of the procedure such as easy availability of the graft and fewer donor site comorbidities. We emphasize upfront urethroplasty and extensive urethral grafting.

Objective assessment of mouth opening after buccal mucosal graft urethroplasty: A prospective study.

Introduction and Objectives:Buccal mucosal graft (BMG) is frequently used for the reconstruction of urethral strictures with acceptable donor-site morbidity after graft harvest. There are only a few prospectively designed studies with a small number of patients reporting oral complications, particularly the mouth opening in the long terms. We did an objective assessment of mouth opening before and after 6 months of BMG urethroplasty as well as pain scores.Materials and Methods:Fifty-eight patients who underwent BMG urethroplasty were included in the study between May 2013 and December 2014. Preoperative mouth opening (reference point between two incisors with the highest of three readings taken as final) was measured using a Vernier caliper. Harvest site was left open to heal by secondary intentions. Postoperatively, mouth opening and pain scores using self-administered (Visual Analog Scale [VAS]) assessed on day 1 and day 3, and follow-up at 1 week, 1 month, and 6 months. Data were analyzed as mean (standard deviation [SD]), proportion, and median (inter-quartile range [IQR]) with two-tailedP < 0.05 as statistically significant.Results:The mean age was 39.6 years. The graft was harvested from a single cheek in 50% of patients. In remaining, it was taken from both cheeks, both cheeks with lip, and both cheeks with the tongue in 29.31%, 17.24%, and 3.5%, of patients, respectively. Preoperative mouth opening (5.13 cm [0.08]) was statistically significantly more than mouth opening on day 1 (4.34 cm [0.09]), day 3 (4.48 [0.09]), and day 7 (4.69 cm [0.09]). Mean difference became insignificant at the interval of 1 month (4.91 cm [0.09]) with 6 months’ values showing marginal improvement over preoperative values (5.14 cm [0.07]). Pain was tolerable and patients reported low median VAS 2 (2–4) on day 1 and day 3 each. Reported median VAS became 0 (0–0) on day 7.Conclusion:Mouth opening restriction after BMG urethroplasty is a definite entity in the initial postoperative period, which becomes nonsignificant by 6 months. The pain has no effect on mouth opening.

Outcome of surgical management of urethral stricture following hypospadias repair

Reconstruction of urethral strictures in patients with a history of hypospadias repair is controversial. The authors policy has been that if a residual healthy urethral plate is present, single-stage urethroplasty is recommended. However, if the urethral plate is fibrotic or absent or if lichen sclerosus is present, two-stage repair is utilized. In this study, the authors report their experience in management of patients with urethral stricture and prior hypospadias surgery. Between 1993 and 2015, 62 patients with urethral stricture and a prior history of hypospadias repair underwent urethroplasty. Patients were divided into two groups; patients in group 1 (n=39) found to have a healthy residual urethral plate and underwent single-stage urethral stricture repair using either an island skin flap or a buccal mucosa graft. Patients in group 2 (n=23) had either a scarred urethra or evidence of lichen sclerosus and underwent staged repair using a buccal mucosa graft. Post-operatively, patients were evaluated at 3 months, 6 months, 1 year, and then annually. The median age of the patients was 10.5 years (2.5-33 years). The mean stricture length was 6.3cm in group 1 and 7.1cm in group 2. Overall success rate was 87.1% in group 1; a urethral fistula occurred in one patient (7.1%) who underwent skin flap onlay repair and one patient (4.5%) with a buccal mucosa graft. Recurrent urethral stricture was also diagnosed in one patient (7.1%) after repair using an island skin flap and in two patients (9%) following buccal mucosa graft. In group 2, three patients (13%) developed graft contracture and were revised before the second stage. Two patients (8.6%) had glans dehiscence following second stage urethroplasty. The final success rate in group 2 was 90.4%. Both single-stage and 2-stage repair showed successful outcome in management of urethral stricture following hypospadias repair. However, the authors continue to believe that the status of the urethral plate dictates the type of surgery to be utilized. In accordance to the previously published data, the study results also further support promising outcomes of application of buccal mucosa in surgical management of these patients. In patients with urethral stricture after hypospadias surgery who have a healthy residual urethral plate, single-stage repair using buccal mucosa graft is a viable option with high success rate. In patients with scarred urethral plate, a 2-stage repair is recommended.

MP55-20 OBJECTIVE ASSESSMENT OF MOUTH OPENING AFTER BUCCAL MUCOSAL GRAFT (BMG) URETHROPLASTY: A PROSPECTIVE STUDY

INTRODUCTION AND OBJECTIVES:Buccal mucosal graft (BMG) is frequently used for reconstruction of urethral strictures with acceptable donor site morbidity after the graft harvest. There are only few ...

Urethral Stricture Reconstruction by Buccal Mucosal Graft Technique

Urethral Stricture Reconstruction by Buccal Mucosal Graft Technique

AB028. The repair and reconstruction of urethral stricture

Urethral stricture is still a challenging field in urology. Despite the varied procedures to treat this disease at present, no one existed approach can be clearly stated to be superior over another. Among the procedures, simple dilation and direct vision internal urethrotomy are more commonly suggested only for short urethral stricture (<1 cm, soft and no previous intervention). Currently, urethroplasty using buccal mucosa or penile skin are the most widely adapted techniques in clinic and have met great success. But some complications such as donor site morbidity still remains problems to be solved. Tissue engineering technique is considered as a promising solution for urethral reconstruction, but still need further investigation, and the stem cell therapy also mandates further work in the future.

Reconstructive Management with Buccal Urethroplasty

We present the historical evolution of the use of buccal mucosa in reconstructive surgery, from the first application in ophthalmology to paediatric surgery and, finally, urethral surgery. This process spanned 99 yr, from 1894 to 1993. The harvesting of buccal mucosa from the cheek requires careful preoperative patient evaluation and selection. To avoid postoperative complications related to the harvesting site, we provide some suggestions based on a large series of patients. The use of a one- or two-stage repair procedure in penile urethroplasty is discussed, and some step-by-step surgical techniques are suggested. The reconstruction of the bulbar urethra using buccal mucosa in traumatic and nontraumatic strictures is also discussed, and different techniques are presented. Finally, appraisal and discussion of some challenging topics (eg, evidence for efficacy, complications, implications, worldwide use) concerning the use of buccal mucosa for urethral stricture reconstruction are presented based on the current literature. Patient summaryWe looked at the history and evolution of the use of buccal mucosa for reconstructive urethral surgery and found that harvesting the buccal mucosa from the cheek is a safe procedure. The use of buccal urethroplasty represents the gold standard in the management of patients with anterior urethral strictures.

Free tubularised vesical mucosa graft for congenital stenosis of the urethra in children

Reconstruction of urethral strictures in children remains a challenge to the pediatric surgeon as these are often related to different rare congenital anomalies with various clinical presentations that endanger renal function and should be repaired in young children. Multiple techniques have been described for their repair. We aimed to determine whether the use of a free tubularised bladder mucosal graft associated to a prior tubeless vesicostomy was feasible and sure, as this technique of reconstruction using tubularised grafts has not been described yet in young children. Two newborn male patients were referred to our department. Both presented a congenital stenosis of the urethra as a part of a complex urethral malformation. Surgery involved prior tubeless vesicostomy, free bladder mucosal graft for urethral reconstruction, and vesicostomy closure for both children. Postoperative evolution was satisfying in both children and cystourethroscopy showed permeable urethra. Satisfying cosmetic and functional results have been obtained in the two cases. The prior vesicostomy prevents kidney damage in the context of complex genital and urinary malformations. Bladder mucosa's immunohistological properties are the most similar to those of the urethral tissue, and are appropriate for this type of correction, making our technique feasible and sure. 5.

Reconstruction of urethral strictures in patients with a long history of blind urethral dilatation.

To compare urethral reconstructions in patients after several years with or without blind urethral dilatation. A retrospective study of 107 patients with urethral reconstructions was performed. Sixty patients with a long history of blind urethral dilatation (group 1) were compared with 47 patients without prior dilatations (group 2). The type of surgery planned according to urethrography and endoscopy findings was appropriate in 37/60 (61.6%) patients in group 1 and in 39/47 (83%) patients in group 2(P < .03). Anastomotic repairs were more frequent among the patients in group 2 (P < .001).Eighty five out of 107 patients were available for the 24 months follow-up. The success rate was higher in group 2 (91.4%) than patients in group 1 (70%) (P < .04). The greatest improvement in symptoms and quality of life occurred three months after the surgery (P < .05).Postoperative infection was persistent in 20/107 (18.7%) patients. Urethral strictures with a long history of blind dilatation are separate entity.They are more difficult to image, require more augmentation and staged procedures and have a lower success rate.

V2-06 RECONSTRUCTION OF THE STRICTURES OF FOSSA NAVICULARIS AND URETHRAL MEATUS BY USING TRANSVERSE ISLAND FASCIOCUTANEOUS PENILE FLAP (TIFP) WITH THE GLANS CAP TECHNIQUE

INTRODUCTION AND OBJECTIVES: Urethral strictures involving the fossa navicularis and external meatus require the reconstruction of both a functional and a cosmetic outlet. We describe our experience with ventral TIFP in the management of distal urethral strictures. METHODS: Between 1997 and 2012, 46 men (mean age: 54 years) with distal urethral strictures confined to the fossa navicularis and urethral meatus underwent ventral TIFP urethroplasty with the glans cap technique. The etiology of the stricture was iatrogenic in 40 (transurethral resection of the prostate or bladder tumor) and inflammatory/ idiopathic in 6. All except 4 patients had undergone multiple previous urethral dilatations. Preoperative evaluation included uroflowmetry with residual urine volume determination, retrograde urethrography (RU) and voiding cystourethrography (VCUG), and urethrocystoscopy with a pediatric ureterorenoscope. During surgery, a subcoronal incision was made on the ventral penile skin and carried down through Buck’s fascia until the urethra. Fossa navicularis and meatus were exposed by dissecting the urethra under the glans. The strictured urethra was then incised ventrally, including the meatus. A ventral fasciocutaneous island flap was mobilized and anastomosed to the edges of the urethral incision, augmenting the urethra to admit a 24-26F sound without difficulty. Urethral catheter was removed after 2 weeks. Patients were followed for obstructive symptoms and 3 monthly uroflowmetric studies in the first year and annually thereafter. Cure was defined as patient satisfaction and the absence of any restenosis requiring additional intervention. RESULTS: Stricture length ranged between 7 to 25 mm. Mean operation time was 50 min. Flap necrosis developed in one patient with subsequent fistula formation. Cure was achieved in 43 (93.4%) men at a mean follow-up of 78 months (range: 3-144). The procedure failed in 2 patients due to lichen sclerosus, which was diagnosed after the recurrence and managed with a 2-stage buccal mucosa graft urethroplasty. The mean Qmax was increased from 7.2 ml/sec preoperatively to 19.4 ml/sec at the last follow-up visit (p1⁄40.001, Wilcoxon sign test). CONCLUSIONS: TIFP is an effective technique for the reconstruction of urethral strictures involving the fossa navicularis and external meatus. It restores a functional and cosmetic outcome with preservation of the glandular integrity. Inflammatory genital skin diseases must be carefully evaluated before surgery to achieve optimum success with this technique.

MP9-10 ASSESSMENT OF FEMALE URETHRAL STRICTURE RECONSTRUCTION: BUCCAL MUCOSA GRAFT AND VAGINAL FLAP

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery III1 Apr 2014MP9-10 ASSESSMENT OF FEMALE URETHRAL STRICTURE RECONSTRUCTION: BUCCAL MUCOSA GRAFT AND VAGINAL FLAP Casey Kowalik, John Stoffel, Leonard Zinman, Alex Vanni, and Jill C. Buckley Casey KowalikCasey Kowalik More articles by this author , John StoffelJohn Stoffel More articles by this author , Leonard ZinmanLeonard Zinman More articles by this author , Alex VanniAlex Vanni More articles by this author , and Jill C. BuckleyJill C. Buckley More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.498AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The management of female urethral strictures is challenging given the variable presenting symptoms and extremely low incidence. Our objective was to evaluate the safety, operative technique and outcomes of women following urethral reconstruction with either a vaginal flap urethroplasty (VFU) or dorsal buccal mucosa graft (BMG). METHODS We retrospectively identified 10 women undergoing urethral reconstruction between February 2007 and October 2012. All patients had active urinary symptoms and/or urodynamic study indicating bladder outlet obstruction, confirmed by cystoscopy. Recurrent stricture was defined by a urethral diameter less than 17fr. Follow-up included urethral calibration (>16fr), symptom assessment, voiding cystourethrogram, and cystoscopy when there was difficulty voiding or symptoms recurred. RESULTS Mean age was 49 years (range 32-74). For urethral reconstruction, 6 patients had a VFU and 4 had a dorsal BMG. Location was mid in 6 and distal in 4 women. The indication for urethral reconstruction was urethral stricture in 9 patients. One woman had a traumatic 2 cm ventral urethral laceration associated with a pelvic fracture. Average stricture length was 1.25 cm (range 0.2-2). All patients with urethral stricture had previously undergone multiple urethral dilations. There were no major post-operative complications. Patients with available data (BMG patients) demonstrated improvement with a median pre-operative maximum flow of 4.5 mL/sec to a median post-operative maximum flow of 10.5 mL/sec. The median post-void residual was 163 mL prior to reconstruction and 25mL at follow-up. Two patients undergoing VFU underwent dilation at an average of 27 months following reconstruction for recurrent stricture with an average follow-up of 41 months. No patients undergoing dorsal BMG had a recurrent stricture or experienced urinary incontinence at an average follow-up of 24 months. CONCLUSIONS Female urethral reconstruction, either VFU or dorsal BMG, is a safe procedure with high success and significant improvements in quality of life. Outcomes of dorsal BMG are promising, demonstrating improved clinical and physiological parameters with maintenance of urinary continence. Women should be offered urethral reconstruction as a definitive management option rather than repeated urethral dilations. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e125 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Casey Kowalik More articles by this author John Stoffel More articles by this author Leonard Zinman More articles by this author Alex Vanni More articles by this author Jill C. Buckley More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Buccal mucosal graft in reconstructive urology: uses beyond urethral stricture.

The use of buccal mucosal grafts for the reconstruction of urethral strictures is an established procedure. Because of its robustness, the buccal mucosal graft could also potentially provide an alternative for other indications in reconstructive urology. We report here six consecutive patients who received a buccal mucosal graft for ureteral strictures, glans reconstruction and stoma stenosis. The follow up for all patients ranged from 26 to 50 months. The buccal mucosal graft showed excellent functional results for the ureteral strictures and stenosis from ureterocutaneostomy. For glans reconstructions, the buccal mucosal grafts delivered excellent cosmetic and functional results without causing meatal stenosis. We conclude the buccal mucosal graft can be used in reconstructive surgery beyond the reconstruction of urethral strictures.

Preputial/penile skin flap, as a dorsal onlay or tubularized flap: a versatile substitute for complex anterior urethral stricture

Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? For long complex anterior urethral stricture augmentation urethroplasty is considered the standard procedure but the best substitute material is still to be ascertained. Preputial/penile skin is a very good substitute especially when used as a dorsal onlay. It demonstrates exceptional functional and cosmetic results even in patients with unsuitable oral mucosa. • To present our experience of single-stage reconstruction of urethral stricture with preputial/penile skin flap, as a dorsal onlay flap (DOF) where there is an adequate urethral plate and as a tubularized flap (TF) where there is a compromised urethral plate, in cases of complex anterior urethral strictures. • We retrospectively reviewed 144 patients, who underwent single-stage repair of pendular /bulbar urethral strictures with preputial/penile flap as either a DOF or a TF, between January 2001 and December 2008. • Patients were divided into three groups: Group 1 consisted of patients who underwent transverse preputial DOF; Group 2 consisted of those who underwent tube urethroplasty; and Group 3 consisted of those patients who were circumcised and for whom the penile skin was used as a DOF (circumpenile flap). • Patients were followed up by physical examination, retrograde urethrography, uroflowmetry and post-void residual urine measurement. • The mean follow-up was 40.1 months (range 36-84 months). • The primary success rates at 1 year follow-up were 90, 85 and 93.3% for Groups1, 2 and 3, respectively, and at 3-years follow-up they were 85, 75 and 86.7%, respectively. • Half of the recurrences were successfully managed with a single visual internal urethrotomy or dilatation. • The secondary success rate was defined as recurrent stricture managed by a single endoscopic procedure and was 5, 10 and 6.8% in Groups 1, 2 and 3, respectively. The overall success rate was 90.85 and 93.3%, respectively. • A total of 75% of the patients in the study completed 60 months of follow-up with no additional recurrence. • A preputial/penile flap for complex anterior urethral stricture is a good treatment option, with results similar to other techniques, has acceptable donor site morbidity and is effective even in circumcised patients and for those patients with unsuitable oral mucosa. • A DOF is less likely to lead to diverticula formation and post-void dribbling. TFs have a higher failure rate than DOFs but, when combined judiciously with secondary endoscopic procedures, can provide good results.

1 RECONSTRUCTION OF URETHRAL STRICTURES FOLLOWING PELVIC RADIATION THERAPY: COMPARISON OF RECONSTRUCTION TECHNIQUES

INTRODUCTION AND OBJECTIVES: Radiation based treatments have proven useful in the management of pelvic malignancy. Urethral stricture is one of the complications of such treatment. The objective of this study is to report outcomes of urethral reconstruction for radiation induced urethral strictures. METHODS: A retrospective review of urethral reconstructions performed by a single surgeon (KR) at the University of Alberta from August 2003 to November 2010 was performed. Patients who underwent reconstruction for urethral strictures after radiation treatment in the form of External Beam Radiation Therapy (EBRT) or prostate Brachytherapy were identified. The primary outcome was urethral patency with secondary outcomes being incontinence and 90-day complication rates. Outcomes were compared between two reconstructive techniques (Excision and Primary Anastomosis versus Tissue Transfer) using the Fisher’s exact test and mean stricture length was compared using the unpaired t-test. RESULTS: During the study period, 507 urethral reconstructions were performed. Of these, 18 met our inclusion criteria including 11 and 7 reconstructions following EBRT and Brachytherapy, respectively. Reconstruction was performed by Excision and Primary Anastomosis (EPA) in 8 (44.4%) of the cases. The remaining patients required Tissue Transfer as either buccal mucosa graft (33.3%) or penile island flap (22.2%). Seventeen patients (94.4%) achieved cystoscopic patency with similar patency rates between the reconstructive techniques (EPA 100%; Tissue Transfer 90%; Not Significant). A 90-day complication rate of 22.2% was reported with 25% and 20% complication rates in the EPA and Tissue Transfer groups respectively (Not Significant). All the complications were Clavien Grade I-II. New onset or adverse change in incontinence occurred in 16.7% of patients. A significant difference was found between the reconstructive techniques with 25% of the EPA reconstructions versus 10% of the Tissue Transfer patients deemed incontinent at 6 months (p 0.013). The overall mean stricture length was 4.3cm. A significantly longer mean stricture length was found in the Tissue Transfer group (EPA 2.13cm vs. Tissue Transfer 6cm; p 0.0001). Mean follow-up was 41.1 months. CONCLUSIONS: Reconstruction of radiation induced urethral strictures yields satisfying rates of success in the outcomes measured. There are no differences in reconstructive technique with regard to urethral patency and 90-day complications. Anastomotic repairs are found to have significantly higher postoperative incontinence rates.

Poster 43: Morbidity of Buccal Mucosal Graft Harvesting for Urethroplasty: A Long-Term Follow-Up Study

Previous studies have investigated early morbidity when using buccal mucosal grafts for reconstruction of urethral strictures. The aim of this study was to investigate long-term objective and subjective morbidity with regards to the oral donor site.

Assessment of the perfusion and morbidity of the buccal mucosal donor site for grafting of urethral strictures

Buccal mucosal grafting has become the gold standard for reconstruction of urethral strictures. The aim of this study was to investigate donor site morbidity with a unique emphasis on objective measurements of perfusion and oxygenation. Methods In a prospective study 15 male patients with recurrent urethral strictures, underwent urethroplasty using an intraoral mucosal graft. Donor site was closed primarily (group 1) or left to granulation (group 2). Clinical examinations of recipient and donor sites, urograms and the modified SF-8™ health questionnaire were carried out 1, 3 and 24 weeks postoperatively. Oxygenation and perfusion parameters of the donor site were measured by the O2C (oxygen-to-see) monitoring device – a combined technique of laser Doppler flowmetry and tissue spectroscopy. Results No recurrence of strictures at recipient site or infections at either sites occurred. 24 weeks after operation, haemoglobin oxygenation (72.1 ± 5.9%) and deep flow (177.2 Arbitrary Units (AU)) of the donor site were slightly, but not significantly, lower compared to the contralateral unoperated buccal mucosa (haemoglobin oxygenation: 75.4 ± 5.2%, deep flow: 187.3 AU). Significant differences between the two groups of different wound healing could not be revealed. Conclusions Using free mucosal grafts for urethroplasty is a simple and safe method in the interdisciplinary treatment of urethral strictures. Donor site morbidity within the first 3 weeks after operation is noticeable, but tolerable measured by a validated Quality of Life-tool. Six months after the operation, perfusion and oxygenation of the former graft harvest site are equal to the contralateral unoperated mucosa.