Urethral Stricture Repair Research Articles

History and Evolution of Dorsal Onlay Urethroplasty for Bulbar Urethral Stricture Repair using Skin or Buccal Mucosal Grafts

Objectives To illustrate the history and the evolution over time of bulbar dorsal onlay urethroplasty, comparing outcomes when using buccal mucosa or skin grafts. Materials and Methods Ninety-four patients underwent bulbar urethral reconstruction using two dorsal onlay techniques, namely augmented anastomotic urethroplasty and dorsal onlay graft urethroplasty. Preoperative evaluation included clinical history, physical examination, urine culture, residual urine measurement, uroflowmetry and urethrography. Thirty-four patients underwent augmented anastomotic urethroplasty using penile skin (10 cases) or buccal mucosa (24 cases) grafts. Sixty patients underwent dorsal onlay graft urethroplasty using penile skin (38 cases) or buccal mucosa (22 cases) grafts. Forty-eight out of 94 patients received skin grafts and 46 buccal mucosal grafts. Results Sixty-four (68%) out of 94 cases were successful, whereas 30 (32%) failed. The 34 augmented anastomotic urethroplasties provided successful outcomes in 24 cases (70.6%), but poor outcomes in 10 (29.4%) cases. The 60 dorsal onlay graft urethroplasty proved to be successful in 42 cases (70%), failing in 18 (30%) cases. Twenty-eight (58.3%) out of 48 penile skin grafts were successful and 20 (41.7%) failed. Thirty-six (78.3%) out of 46 buccal mucosa grafts were successful and 10 (21.7%) failed. The 30 failed cases were then treated with internal urethrotomy in 14 cases (46.7%), perineal urethrostomy in 8 cases (26.7%), two-stage repair in 4 cases (13.3%), and one-stage repair in 4 cases (13.3%). Conclusions The dorsal onlay technique used for bulbar urethral stricture repair has changed over time. In our experience, the buccal mucosa seems to be the best substitute graft material for bulbar urethroplasty using dorsal approach.

Buccal Mucosa Graft Urethroplasty for Anterior Urethral Stricture Repair: Evaluation of the Impact of Stricture Location and Lichen Sclerosus on Surgical Outcome

We report our experience with buccal mucosa grafts for anterior urethral strictures. We compared outcomes in the pendulous and bulbar urethra as well as the impact of lichen sclerosus on success. A total of 53 men underwent buccal mucosa graft urethroplasty from 1997 to 2004 for strictures of all etiologies, including lichen sclerosis in 13. Of the patients 46 underwent 1-stage repair and 7 with full-thickness circumferential disease underwent multistage repair. For 1-stage repair strictures were limited to the bulb in 33 cases and they involved the pendulous urethra in 13. A dorsal onlay was used in 24 cases and a ventral onlay was used in 22. For multistage urethroplasty 2 strictures were in the bulbar urethra and 5 were in the pendulous urethra. Success was defined as no postoperative procedures or complications. The success rate of all urethroplasties was 81% (43 of 53 cases) at a mean followup of 52 months. For bulbar vs pendulous urethroplasty the success rate was 86% (30 of 35 cases) vs 72% (13 of 18, p = 0.23). For 1-stage urethroplasty by graft location success was achieved in 20 of 24 cases (83%) for dorsal onlay vs 17 of 22 (77%) for ventral onlay (p = 0.61), in 18 of 21 (86%) for bulbar-dorsal onlay, in 10 of 12 (83%) for bulbar-ventral onlay, in 2 of 3 (66%) for pendulous-dorsal onlay and in 7 of 10 (70%) for pendulous-ventral onlay. For multistage urethroplasty success was achieved in 2 of 2 cases (100%) for bulbar repair vs 4 of 5 (80%) for pendulous repair. In the 13 patients with lichen sclerosus success was achieved in 4 of 8 (50%) with 1-stage repair vs 4 of 5 (80%) with multistage repair (p = 0.28). Complications developed in 10 of 53 cases (19%), including fistula in 1, urinary tract infection in 1 and stricture in 8 that required treatment, including dilation in 3, internal urethrotomy in 4 and perineal urethrostomy in 1. Five of these 8 recurrent strictures (63%) developed in patients with lichen sclerosus, including 4 in urethras in which 1-stage repair was done for lichen sclerosus. There were no donor site complications, postoperative erectile dysfunction or chordee. A buccal mucosa graft placed dorsally or ventrally remains an excellent graft material in the bulbar and pendulous urethra. When lichen sclerosus is present, careful consideration should be given to complete excision of the diseased urethra with multistage repair vs accepting a higher rate of stricture recurrence with 1-stage repair.

POS-02.142: Results of buccal mucosal graft onlay patch urethroplasty in the repair of adult bulbar urethral stricture

Buccal mucosa has been advocated as an ideal graft material for urethral reconstruction in adults. We report our experience with buccal mucosal onlay urethroplasty for complex bulbar urethral reconstruction in adults.

Esthetic Outcomes of Genitoplasty in Males Born With Bladder Exstrophy and Epispadias

Male children born with bladder exstrophy-epispadias complex may have poor self-image because the esthetic aspects of the genitalia acquire greater significance with age. We reviewed our long-term outcomes of genitoplasty in males born with exstrophy-epispadias complex with emphasis on the esthetic results. A total of 70 male patients with exstrophy-epispadias complex were the basis of this retrospective review. Primary and secondary genitoplasty was performed in 44 and 26 patients, respectively. Various surgical methods were implemented for genitoplasty, including Cantwell Ransley technique with or without paraexstrophy flaps in 36 cases, partial corporeal mobilization with or without dermal graft in 16, subperiosteal corporeal mobilization from the pubic rami in 7 and complete penile disassembly in 6. The parent and when appropriate the patient determined satisfaction with the cosmetic appearance. The incidence of postoperative complications and need for surgical revision were noted. Long-term followup was available in 65 of 70 patients. Esthetic satisfaction was present in 60 of 65 patients (92%). A total of 19 revisions (29%) were required with 4 patients undergoing multiple revisions. These revisions included fistula repair, repair of urethral stricture, glanular contouring and recurrent chordee release. The penile malformations observed in exstrophy-epispadias complex may be due to a short urethral strip, corporeal disproportion and/or iatrogenic scarring. The optimal method to correct corporeal disproportion includes placement of a dermal graft. In select cases careful and partial mobilization of the crura from the pubic rami allows penile lengthening. In secondary reconstructive efforts subperiosteal dissection provides a virgin surgical field, while protecting neurovascular and erectile structures.

Traumatic Obliterative Urethral Strictures in Pediatric Patients: Failure of the Cut to Light Technique at Long-Term Followup

The cut to light procedure or antegrade and retrograde urethroscopy with endoscopic incision of obliterative urethral strictures is an accepted method of treating posterior urethral distraction injuries. We report long-term followup on 22 pediatric patients treated with this technique. The records of all pediatric patients with a posterior urethral distraction injury treated from 1986 through 2006 were reviewed. The cut to light procedure was performed for obliterative strictures less than 1 cm via a cold knife or laser in 11 patients each. A urethral catheter was left in situ for 3 weeks. Patients were then followed a minimum of 2 years. A total of 22 patients at a median age of 11 years (range 3 to 16) were treated. Followup revealed stricture recurrence in all patients. Median time to recurrence was 3 months after catheter removal (range 5 days to 1 year). Although intermittent catheterization to maintain patency was attempted in all patients, the development of impassable urethral strictures in 16 (73%) and complaints of chronic pain with catheterization in 4 (18%) led to end-to-end urethroplasty. Successful reconstruction with open surgery was achieved in 19 of 20 patients (95%). Two patients (9%) maintained urethral patency with intermittent catheterization. In children with obliterative posterior urethral distraction injuries a cut to light procedure had a long-term success rate of 0%. All patients required daily intermittent catheterization (9%) or formal urethral reconstruction (91%) to maintain patency. We would strongly recommend against treating pediatric obliterative urethral strictures with a cut to light procedure.

The Effect of Bulbar Urethroplasty on Erectile Function

Theoretically bulbar urethroplasty has the potential to adversely affect potency, involving as it does dissection in proximity to the corporeal bodies and erectile neurovascular structures. We prospectively examined the effect of various bulbar urethroplasties on erectile function. Prior to undergoing urethroplasty, patients completed an International Index of Erectile Function questionnaire. Each patient repeated the International Index of Erectile Function at least 3 months postoperatively. One-sided t and Fisher's exact tests were used to compare preoperative and postoperative erectile function. A total of 25 men with an average age of 39 years (range 26 to 66) completed the study. Etiology of stricture was idiopathic in 20 patients and traumatic in 5. Stricture location was panbulbar in 5 patients, mid to posterior bulbar in 13 and mid to distal bulbar in 7. Eight men underwent anastomotic urethroplasty, 15 underwent augmented anastomotic repair using a buccal mucosal graft and 2 underwent a dorsal onlay. At a mean of 6.2 months of followup, average total International Index of Erectile Function went from 62.6 to 59.6 of 75 possible points and the average erectile function domain score went from 26.9 to 24.8 of 30 possible points. Neither of these differences attained significance (p = 0.29 and 0.13, respectively). A total of 25 men had an erectile function domain postoperative score of greater than 20 and 8 had a score of 20 or less. Men with a score of 20 or less were older (47 vs 36.8 years, p = 0.17) and had worse preoperative erectile function (20 vs 29, p = 0.11) than those with erectile function scores greater than 20, although these differences did not achieve significance. We report on men undergoing 4 variations of bulbar urethroplasty. Although the numbers are small, we found that such surgery had an insignificant effect on erectile function. Surgical complexity with long stricture excision and the use of a buccal graft did not influence outcome.

Augmented Anastomotic Urethroplasty

During substitution urethroplasty, if the stricture contains a 1 to 2 cm region that is particularly narrow and/or fibrotic, that portion may be excised with subsequent anastomosis of the dorsal or ventral aspect of the urethra to shorten, widen and optimize the urethral wall onto which an onlay graft is to be placed. This procedure is termed augmented anastomotic urethroplasty. To determine the effectiveness of this approach we reviewed our experience with augmented anastomotic urethroplasty in an 8-year period. We reviewed the records of patients who underwent augmented anastomotic urethroplasty between October 1997 and April 2005. Perioperative characteristics were compared between successes and failures using the Wilcoxon/Kruskal-Wallis and Fisher exact tests. Of 69 patients who underwent augmented anastomotic urethroplasty for recurrent urethral strictures 5 had undergone previous urethroplasty using a genital skin flap or graft. At a median followup of 34 months (range 13 to 103) 62 patients had no evidence of stricture recurrence and required no further intervention for an overall success rate of 90%. Stricture recurrence, defined as the inability to easily pass a standard flexible cystoscope through the area of repair, occurred in 7 patients (10%). Patients with stricture recurrence were significantly older (mean age 52 vs 39 years, p = 0.02) and more likely to experience postoperative urinary tract infection (28% vs 3.2%, p = 0.05) than patients without repeat stricture. Augmented anastomotic urethroplasty is an effective technique that allows the use of a shorter onlay graft. It may optimize overall results due to improvement in the urethral wall and the associated corpus spongiosum.

History and evolution of dorsal onlay urethroplasty for bulbar urethral stricture repair using skin or buccal mucosal grafts

OBJECTIVES. To illustrate the history and the evolution over time of bulbar dorsal onlay urethroplasty, comparing outcomes when using buccal mucosa or skin grafts. MATERIALS AND METHODS. Ninety-four patients underwent bulbar urethral reconstruction using two dorsal onlay techniques, namely augmented anastomotic urethroplasty and dorsal onlay graft urethroplasty. Preoperative evaluation included clinical history, physical examination, urine culture, residual urine measurement, uroflowmetry and urethrography. Thirty-four patients underwent augmented anastomotic urethroplasty using penile skin (10 cases) or buccal mucosa (24 cases) grafts. Sixty patients underwent dorsal onlay graft urethroplasty using penile skin (38 cases) or buccal mucosa (22 cases) grafts. Forty-eight out of 94 patients received skin grafts and 46 buccal mucosal grafts. RESULTS. Sixty-four (68%) out of 94 cases were successful, whereas 30 (32%) failed. The 34 augmented anastomotic urethroplasties provided successful outcomes in 24 cases (70.6%), but poor outcomes in 10 (29.4%) cases. The 60 dorsal onlay graft urethroplasty proved to be successful in 42 cases (70%), failing in 18 (30%) cases. Twenty-eight (58.3%) out of 48 penile skin grafts were successful and 20 (41.7%) failed. Thirty-six (78.3%) out of 46 buccal mucosa grafts were successful and 10 (21.7%) failed. The 30 failed cases were then treated with internal urethrotomy in 14 cases (46.7%), perineal urethrostomy in 8 cases (26.7%), two-stage repair in 4 cases (13.3%), and one-stage repair in 4 cases (13.3%). CONCLUSIONS. The dorsal onlay technique used for bulbar urethral stricture repair has changed over time. In our experience, the buccal mucosa seems to be the best substitute graft material for bulbar urethroplasty using dorsal approach.

V-05.08: The use of buccal mucosal grafts in reconstructive urethral surgery

Buccal mucosa has become an increasingly popular graft tissue for anterior urethroplasty because is readily available from all patients and is easily harvested from the inner cheek or lower lip with a concealed donor site scar. In the video the authors present a wide view of the one stage or multistage procedures for the repair of anterior urethral strictures using buccal mucosal grafts.

Small intestine submucosa in urethral stricture repair in a consecutive series

Objectives To define the feasibility of acellular porcine small intestine submucosa (SIS) as a xenograft implant. SIS is commercially available and approved for use in humans. Methods Five patients underwent open surgery for urethral stricture repair using SIS and a four-layer SIS graft. Two patients had a bulbar stricture and three had a combined penile-bulbar stricture. The median stricture length was 9 cm (range 3.5 to 10). All patients underwent at least one internal urethrotomy. The urethral stricture repair was performed as an onlay urethroplasty. SIS was used to augment the urethral caliber at the stricture site. A catheter and percutaneous cystostomy for drainage were placed. The catheter was removed 10 days after surgery. Three weeks postoperatively, voiding cystourethrography and retrograde urethrography were performed. Results Preoperatively, flow studies were available for 3 patients, in 1 patient voiding was not possible because of urinary retention, and in 1 patient the preoperative flow study was not available (surgery was performed on the basis of the preoperative urethrographic findings). The mean maximal flow rate was 4.2 mL/s (n = 3); the mean value of the mean flow rate was 2.6 mL/s (n = 3). Postoperatively, 1 patient had extravasation, which was treated by prolonged suprapubic drainage. One patient had severe urethritis and one urinary tract infection. Four patients had a recurrent stricture after a mean of 12.4 months (range 3.7 to 17.5). Two patients underwent open repair using buccal mucosa and two refused repeated surgery. Conclusions In 4 patients, the operation was not successful. Because of the poor results, we discontinued the use of SIS for open urethral stricture repair.

Experience with fibrin glue in bulbar urethral reconstruction using dorsal buccal mucosa graft

Buccal mucosa dorsal onlay graft urethroplasty represents a widespread method for bulbar urethral stricture repair. We describe a modified procedure with the use of fibrin glue applied on the receiving bed before graft location.

97 Flap or no flap in repair of urethral stricture

Introduction: When recurrent strictures become troublesome to deal with endoscopically and excision and anastomotic repair is not possible, substitution urethroplasty employing various pedicle flaps repair is the treatment of choice. In the past, foreskin flap, penile skin and scrotal skin had been employed with varying success. Unfortunately with long term follow up all skin repairs have high degree of recurrent UTI, recurrent stricture, stone formation, lichen sclerosus changes at the flap and diverticulum formation. Buccal mucosal free patch graft repair has gained wide acceptance after early reporting by G Barbagli in its use as dorsal onlaid graft in early 90's. The author reported his early work back in 1998, modifying the dorsal onlaid graft to ventral graft attracted criticism. With long‐term follow up and recent reporting from the Barbagli unit using the dorsal onlaid graft, the result presented from our unit is comparable to other major units around the world with minimal complications.Result: Between 1996 and 2005, 126 patients had BM ventral onlaid graft urethroplasty for recurrent strictures. All patients tertiary referred had previous dilatation, optical urethrotomy and some had previous substitution urethroplasties. Before 1996, pedicle penile skin graft was commonly used in our unit to repair urethral stricture at the bulbar or penile urethra. Many scrotal onlaid grafts were revised. In this group of pedicle skin urethroplasties, UTI and postmicturition dribbling were commonly reported by pts. All pts after BM graft urethroplasty had follow up cystoscopy at 3 and 15 months to assess and calibrate their graft luminal size before discharge from the unit. The length of the graft ranged from 2.5 to 15 cm. The graft has been employed to repair stricture from meatus to proximal bulbar urethra. The recurrent stricture usually occurs at the junctional area, either proximal or distal graft anastomotic site. Recurrent stricture tends to occur in the three and six months period. Revision urethroplasty for recurrent stricture in this group of patients was 12%. Two out of 126 patients required complete revision of their graft due to significant shrinkage secondary to recurrent UTI. One pt developed urethral cutaneous fistula at the penile scrotal junction. Postmicturition dribbling secondary to diverticulum formation is not a feature in this group of pts and ejaculatory dysfunction has not been reported.Conclusion: Modified ventral onlaid BM graft urethroplasty has been proven a reliable long‐term solution to pts with recurrent stricture that require substitution urethral reconstruction. The use of pedicle skin flap substitution urethroplasty is limited due to high complication rate in long‐term follow up.

The Tongue as an Alternative Donor Site for Graft Urethroplasty: A Pilot Study

Urethroplasty with a buccal mucosal graft provides excellent clinical results but it may also cause oral complications in some cases. The mucosa covering the lateral and under surface of the tongue is identical in structure with that lining the rest of the oral cavity. We evaluated LMGs for urethroplasty. From January 2001 to September 2004, 8 men 34 to 65 years old (mean age 46.1) with urethral strictures 1.5 to 4.5 cm long were selected for 1-stage dorsal onlay urethroplasty. The site of the harvest graft was the lateral mucosal lining of the tongue. Postoperatively all patients were followed with urethrography, uroflowmetry, cystourethrography and flexible urethroscopy after 3 and 12 months. Successful reconstruction criteria were peak flow rate greater than 15 ml per second and no need for postoperative urethral dilation. Median followup was 18 months (mean 22.1, range 3 to 47). Seven cases were successful. One patient had a partial urethral stricture. In successful cases cystourethrography revealed no significant graft contractures or sacculations and at flexible urethroscopy LMG was almost indistinguishable from native urethra. There were no pain, esthetic or functional complications at the donor site. Harvesting the LMG is feasible and easy to perform. Compared with the buccal mucosal graft the LMG seems to be associated with less postoperative pain and a minor risk of donor site complications. These preliminary functional and esthetic data are satisfactory.

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.

Perineal Anastomotic Urethroplasty for Managing Post-Traumatic Urethral Strictures in Children: The Long-Term Outcome

OBJECTIVE To evaluate the long-term results of one-stage perineal anastomotic urethroplasty for post-traumatic paediatric urethral strictures. PATIENTS AND METHODS Thirty-five boys who had a perineal anastomotic urethroplasty for post-traumatic bulbous or posterior urethral strictures between 1991 and 2003 were analysed retrospectively. Patients were followed up for a mean (range) of 46 (6-132) months by a history, urinary flow rate estimate, retrograde urethrography and voiding cysto-urethrography. RESULTS The mean (range) age of the patients was 11.9 (6-18) years. The estimated radiographic stricture length before surgery was 2.6 (1-5) cm. The perineal anastomotic repair was successful in 31 of 35 (89%) patients. All treatment failures were at the anastomosis and were within the first year. Failed repairs were successfully managed endoscopically in two patients and by repeat perineal anastomotic repair in the remaining two, giving a final success rate of 100%. All boys are continent except two who had early stress incontinence, and that resolved with time. There was no chordee, penile shortening or urethral diverticula during the follow-up. CONCLUSIONS The overall success of a one-stage perineal anastomotic repair of post-traumatic urethral strictures in boys is excellent, with minimal morbidity. Substitution urethroplasty or abdomino-perineal repair should be reserved for the occasional patients with concomitant anterior urethral stricture disease or a complex posterior urethral stricture, respectively.

A Comparison of One-Stage Procedures for Post-Traumatic Urethral Stricture Repair

No AccessJournal of UrologyUrological Survey: Trauma, and Genital and Urethral Reconstruction1 Dec 2005A Comparison of One-Stage Procedures for Post-Traumatic Urethral Stricture Repair Allen F. MoreyM.D. Allen F. MoreyAllen F. Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)68978-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "A Comparison of One-Stage Procedures for Post-Traumatic Urethral Stricture Repair." The Journal of Urology, 174(6), pp. 2264–2265 References 1 : Anterior urethral strictures: etiology and characteristics. Urology2005; 65: 1055. Google Scholar 2 : Failed anterior urethroplasty: guidelines for reconstruction. J Urol1997; 158: 1383. Link, Google Scholar 3 : Management of urethral stricture disease: developing options for surgical intervention. BJU Int2004; 94: 971. Google Scholar © 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 174Issue 6December 2005Page: 2264-2265 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information Allen F. Morey More articles by this author Expand All Advertisement PDF DownloadLoading ...

A Comparison of One-Stage Procedures for Post-Traumatic Urethral Stricture Repair

A Comparison of One-Stage Procedures for Post-Traumatic Urethral Stricture Repair

BULBAR URETHROPLASTY USING BUCCAL MUCOSA GRAFTS PLACED ON THE VENTRAL, DORSAL OR LATERAL SURFACE OF THE URETHRA: ARE RESULTS AFFECTED BY THE SURGICAL TECHNIQUE?

The use of buccal mucosa graft onlay urethroplasty represents the most widespread method of bulbar urethral stricture repair. The graft may be placed on the ventral or dorsal urethral surface according to surgeon experience and preference. We investigated whether the results are affected by the surgical technique by comparing the outcome of 3 types of bulbar urethroplasty using buccal mucosa graft. We repaired 50 bulbar urethral strictures with buccal mucosa grafts from 1997 to 2002. Mean patient age was 42 years. The etiology of stricture was ischemia in 12 cases, trauma in 6, instrumentation in 4 and unknown in 28. Patients with lichen sclerosus, failed hypospadias or urethroplasty and stricture extending into the penile urethra were not included. A total of 47 patients (94%) had undergone previous urethrotomy or dilation. The buccal mucosa graft was always harvested from the cheek using a 2 team approach. Mean graft length was 4.2 cm. The graft was placed on the ventral, dorsal and lateral bulbar urethral surface in 17, 27 and 6 cases, respectively. Clinical outcome was considered a success or failure at the time that any postoperative procedure was needed, including dilation. Mean followup was 42 months (range 12 to 76). Of 50 cases 42 (84%) were successful and 8 (16%) failed. The 17 ventral grafts provided success in 14 cases (83%) and failure in 3 (17%). The 27 dorsal grafts provided success in 23 cases (85%) and failure in 4 (15%). The 6 lateral grafts provided success in 5 cases (83%) and failure in 1 (17%). No surgical complications were observed. Failures involved the anastomotic site (distal in 2 and proximal in 3) and the whole grafted area in 3 cases. They were treated with urethrotomy in 5 cases and 2-stage urethroplasty in 3. In our experience the placement of buccal mucosa grafts into the ventral, dorsal or lateral surface of the bulbar urethra showed the same success rates (83% to 85%) and the outcome was not affected by the surgical technique. Moreover, stricture recurrence was uniformly distributed in all patients.

Dorsal Onlay Graft Urethroplasty Using Penile Skin or Buccal Mucosa for Repair of Bulbar Urethral Stricture: Results of a Prospective Single Center Study

ObjectiveTo compare the outcomes of dorsal onlay graft urethroplasty using penile skin (PS) or buccal mucosa (BM) free grafts in the repair of adult bulbourethral strictures. MethodsFrom January 1998 to March 2003, 30 patients with bulbar urethral strictures underwent urethral reconstruction with PS (17) or with BM free graft (13). Follow-up was done at 6, 12 and 18 months postoperatively, and every year subsequently. Success was defined as normalization of IPSS and a stable Qmax value >20ml/s. Any further instrumentation for stricture recurrence was considered a failure. ResultsMean follow-up was 51 months (20–74). The overall success rate was 80% (85% in the BM and 76% in the PS group). Improvement of uroflowmetry, IPSS and QoL did not show a significant difference between the two groups. A significant improvement of the orgasmic function domain of the IIEF was found in patients treated with a PS graft. Post-operative complications were lip hypoesthesia (30%), retraction of the ventral skin of the penis (7%), post-voiding dribbling (8% with BM graft, and 7%, with PS graft). Six patients, 2 with BM (15%) and 4 with PS graft patch (24%) required further treatment due to stricture recurrence. ConclusionResults of PS or BM graft are comparable at 18 month follow-up, although orgasmic function is significantly improved in patients receiving a PS graft. Nevertheless, with extended follow-up, the use of PS seems to be associated with a higher failure rate.

A comparison of one‐stage procedures for post‐traumatic urethral stricture repair

To compare the results and complication rates of various one-stage treatments for repairing a post-traumatic urethral stricture. The medical records of 153 patients who had a post-traumatic urethral stricture repaired between 1977 and 2003 were evaluated retrospectively, and analysed for the different types of urethral reconstruction. The procedures included direct end-to-end anastomosis in 86 (56%) patients, free dorsal onlay graft urethroplasty using preputial or inguinal skin in 40 (26%), ventral onlay urethroplasty using buccal mucosa in seven (5%) and ventral fasciocutaneous flaps on a vascular pedicle in 20 (13%). At a mean (median, range) follow-up of 75.2 (38, 12-322) months, 121 (79%) patients had no evidence of recurrent stricture, while in 32 men (21%) they were detected at a mean follow-up of 30.47 (1-96) months. Patients having a dorsal onlay urethroplasty had the longest strictures. The re-stricture rate was lowest after a dorsal onlay urethroplasty (5% vs 27% when treated with end-to-end anastomosis, 15% after fasciocutaneous flaps and 57% after a ventral buccal mucosal graft). The surgical technique used had no effect on postoperative incontinence or erectile dysfunction rates. In patients with strictures which are too long to be excised and re-anastomosed, tension-free dorsal onlay urethroplasty is better than ventral graft or flap techniques. In patients with short urethral strictures direct end-to-end anastomosis remains an option for the one-stage repair of urethral stricture.