Segment Anterior Urethral Stricture Research Articles

Clinical Study of Single Stage Dorsolateral Onlay Buccal Mucosal Graft Urethroplasty in Long Segment Anterior Urethral Stricture

1.1. Objectives: To evaluate the results of dorsolateral onlay buccal mucosal graft (BMG) urethroplasty in various types of long segment anterior urethral stricture. 1.2. Materials and Methods: This is a prospective study, conducted in the Department of Urology, Medical College, Kolkata and Burdwan Medical College, Burdwan from April 2017 to March 2021. Forty patients with long segment (more than 1.5 cm) anterior urethral stricture who underwent substitution urethroplasty using dorsolateral onlay BMG urethroplasty were evaluated with detailed history, physical examination, ultrasonography of KUB with PVRU, uroflowmetry, retrograde urethrography and voiding cystourethrography, sono-urethrograms and cystoscopy. After treatment with dorsolateral onlay BMG urethroplasty, they were followed-up with uroflowmetry at 3 monthly interval for one year and RGU and/or urethroscopy if indicated. Success was defined as normal voiding pattern without any intervention post-operatively. 1.3. Results: With nineteen of the forty cases (47.5%), lichen sclerosus formed the single most common etiology. Panurethral strictures were more common. Out of total 40 cases, 33 (82.5%) had successful outcome and 7 (17.5%) were failure. 1.4. Conclusion: We conclude that it is a simple, technically feasible, easily adoptable and finally successful procedure

Dorsal Onlay Buccal Mucosal Graft Urethroplasty for Long Segment Anterior Urethral Strictures: A Retrospective Study of Mid and Long-term Outcomes

Introduction: Dorsal onlay urethroplasty with Buccal Mucosal Graft (BMG) is the single stage procedure and is most commonly used to treat long segment anterior urethral strictures. Unilateral mobilisation of the urethra prevents both chordee and ischaemia. Aim: To evaluate the feasibility, medium-term and long-term outcomes of dorsal onlay BMGs when used to treat long anterior segment penile urethral stricture with unilateral mobilisation of the urethra. Materials and Methods: A retrospective study was conducted in Kasturba Hospital, Manipal, Karnataka, India, from January 2008-December 2018. A total of 56 patients with long anterior segment penile urethral strictures underwent BMG substitution for urethroplasty, with a follow-up period ranging from 1.2-10 years. The outcome of the procedure was assessed through clinical history and physical examination, uroflowmetry, retrograde and voiding cystourethrography and urethroscopy {6 French gauge (Fr)}. Statistical analysis was performed using the mean and median. Results: The mean age of 56 patients was 51.8±9.9 years, with a mean±Standard Deviation (SD) Maximum Flow Rate (MFR) of 20.1±5.3 mL at one month and 18.1±4.3 mL at three and 18.7±3.7 mL six months, 17.3±5.1 mL, 19.3±4.3 mL and 18.6±3.7 mL at one year, 2-5 years and 10 years postoperative respectively. Postvoid Residual urine (PVR) volume was higher till one year follow-up (i.e., 1st month it was 38.6±23.6 mL in 47 patients, 3rd month it was 45.8±22.4 mL in 12 patients, 6th month it was 49.0±28.8 mL in 14 patients and one year follow-up it was 43.9±30.8 mL in 24 patients). Minimal complications were noted over 5-10 years follow-up. Conclusion: For long segment anterior penile urethral strictures, unilateral mobilisation in BMG urethroplasty had shown success over both medium and long-term periods.

Comparison of two different methods of establishment of canine urethroplasty model: an experimental trial

BackgroundGraft substitute urethroplasty is recommended for patients with long segment anterior urethral stricture. The therapeutic effects of the grafts need to be validated on the animal models. Therefore the aim of this study was to compared the operative time, blood loss, intra- and post- operative complications of two different methods of establishment of canine urethroplasty model.MethodsTwelve Beagle dogs were randomly separated into control and experimental group using a random number table. Six animals in the control group received the conventional urethroplasty, while the other 6 in the experimental group received the modified procedures. Tube cystostomy and urethroplasty were performed in the control group. The cystostomy not the tube cystostomy were performed in the experimental group, and the testes were simultaneously removed with the scrotum. Per- and postoperative outcomes, complications were evaluated.ResultsThe urethroplasty were successfully performed for all dogs and all of these procedures were done by the same surgeon. The median operative time in the control and experimental groups was 186.8 min and 188.7 min respectively. The blood loss in the control and experimental groups was 40.8 ml and 45.8 ml respectively. No intraoperative complications occurred. 3 animals in the control group developed acute urinary retention after the accidental removal of suprapubic bladder tube and the cystostomy was done again. There was no occurrence of urinary retention in the experimental group. 4 animals in the control group developed the perineal hematoma, in which one animal had the urine leakage and incision infection. Perineal hematoma occurred in only one animal in the experimental group.ConclusionThe occurrence of urinary retention and perineal hematoma decreased in the modified group, in which the cystostomy not the tube cystostomy were performed and the testes with the scrotum were simultaneously removed.

Substitution Buccal Mucosal Graft Urethroplasty for Long Segment Anterior Urethral Stricture : Our Experience in Dorsolateral Onlay Approach

Background: Currently the most favorable single stage procedure for management of long segment anterior urethral stricture is dorsal onlay technique of urethroplasty. This required circumferential extensive mobilization of the urethra, which might cause ischemia of urethra in addition to chordee. To evaluate the short term outcome of dorsolateral onlay BMG (Buccal Mucosal Graft) urethroplasty by unilateral urethral mobilization for treatment of long segment anterior urethral stricture
 Materials and methods: A prospective experimental study from January 2016 to December 2018 is carried out in Department of Urology, Chittagong Medical College Hospital (CMCH) Chattogram, Bangladesh. Total 32 patients of long segment anterior urethral stricture were treated by dorsolateral onlay BMG urethroplasty by unilateral urethral mobilization. Stricture >2cm were included; RGU, MCU and Uroflowmetry were the mainstay of assessment. Success was defined as maximum flow rate >15 ml/s, normal RGU and/ urethroscopy. Failure considered as presence of obstructive symptoms, Qmax < 15 ml/s, stricture on RGU and any post-operative urethral intervention.
 Results: Mean stricture length was 48.72mm (Range: 30-77mm) and mean follow up time was 22.4months (Range: 12-40 months). Three patients were found to develop stricture at proximal anastomotic site during follow up and required optical internal urethrotomy and considered as failure. 01 patients developed Surgical Site Infection (SSI) which resolved after regular dressing. Success rate was 90.7%
 Conclusion: Dorsolateral onlay BMG urethroplasty by unilateral mobilization is feasible, safe and easily adoptable for long segment anterior urethral stricture with good short term outcome.
 Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 14-17

Lichen sclerosis-induced long segment anterior urethral stricture: The early outcome of one-stage repair using dorsolateral onlay buccal mucosa graft.

Substitution urethroplasty using buccal mucosal grafts can be performed by several approaches including ventral onlay graft, dorsal onlay graft, or ventral urethrotomy with dorsal inlay graft. Our study aims to evaluate the surgical outcome of dorsolateral buccal mucosal graft for long segment anterior urethral stricture >6 cm in patients with Lichen sclerosus (LS). A retrospective study included patients who underwent repair for long segment anterior urethral stricture >6 cm due to LS between January 2013 and April 2019. All patients were followed-up at 3, 6, 9, and 12 months postoperatively and then yearly by clinical symptoms, uroflowmetry, and calculation of post-void residual urine volume. Retrograde urethrogram was requested for patients with voiding symptoms or decreased maximum flow rate. Stricture recurrence that required subsequent urethrotomy or urethroplasty was considered failure. The success rate and surgical complications were collected and analyzed. Thirty patients were identified. The median age (range) was 39 (25-61) years and a median (range) stricture length was 8 (6-14) cm. Most of postoperative complications were of minor degree. The success rate at median follow-up of 15 (12-24) months was 86.5%. The median maximum flow rate increased significantly from 6 (2-11) ml/s preoperatively to 18 (range: 6-23) ml/s at the 6th month (p value < 0.001). Dorsolateral buccal mucosal grafts urethroplasty for long anterior urethral stricture caused by LS has a high success rate and low risk of complications including stricture recurrence.

Outcome Between Intralesional Injection of Triamcinolone following Optical Internal Urethrotomy (OIU) and OIU Alone for the Management of Short Segment Stricture of male Urethra

Objective: To compare the outcome of optical internal urethrotomy (OIU) with or without intralesional triamcinolone acetonide injection for the treatment of short segment anterior urethral stricture.&#x0D; Methods: This prospective quasi experimental study was carried out in the department of Urology, DMCH, Dhaka from November 2015 to April 2017 on 50 patients with short segment of anterior urethral stricture. Cases were randomly allocated to group A (OIU without Triamcinolone) and group B (OIU with Triamcinolone). Each group consisted of 25 patients. Data were analyzed and compared by statistical tests.&#x0D; Results: There were no significant differences in the baseline characteristics of the patients. Recurrences of stricture urethra were higher among those without Triamcinolone than cases with Triamcinolone which was statistically significant (p=0.033) at 6 month and (p=0.016) at 9 months. Regarding mean time interval in month of development of recurrence of stricture was 6.1±1.66 months in Group A and 7.66±1.52 months in Group B which was statistically significant (p=0.001)&#x0D; Conclusion: OIU with intralesional triamcinolone is better than OIU alone. It significantly reduced and delayed the recurrence of anterior urethral stricture.&#x0D; J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 126-130

Everted Saphenous Vein Graft (eSVG) urethroplasty in long-segment anterior urethral strictures: Medium-term follow-up results

Purpose: An everted saphenous vein graft (eSVG) has been used for urethroplasty in men with long segment anterior urethral stricture and chronic tobacco exposed oral mucosa with good initial results. The present study aimed to assess the medium-term outcomes of eSVG urethroplasty (eSVGU) in such patients. Materials and Methods: Prospectively maintained database of 32 patients with chronic tobacco exposed oral mucosa, who underwent an eSVGU for long segment anterior urethral stricture (≥9 cm), was reviewed. Outcomes were assessed with International Prostate Symptom Score (IPSS), uroflowmetry with postvoid residual urine at 1, 3, and 6 months, and thereafter 6 monthly symptomatic assessments. Retrograde urethrogram was done at 3 months and repeated only if there was a recurrence. Successful urethroplasty was defined as satisfactory voiding (maximum flow rate [Qmax] >15 ml/sec) and no need for any auxiliary procedures in follow-up. Patients who lost to follow-up before 3 years were excluded from the final analysis. Data from the patients were recorded on a spreadsheet and expressed as mean and standard deviation wherever feasible. Results: Mean stricture length was 13.75 cm. Two patients were lost to follow-up after 12 months and were excluded from the final analysis. At a mean follow-up of 58 months, 19 patients (63.33%) were voiding successfully with mean IPSS 8.15 and Qmax 23.54 ml/s respectively, while 11 patients (36.67%) required auxiliary procedures and were considered failed. Conclusion: Medium-term results suggest that an eSVG can be considered as a good alternative graft for urethroplasty in patients with long anterior urethral strictures.

A single stage urethroplasty with dorsal onlay buccal mucosal graft for long segment anterior urethral stricture caused by Balanitis Xerotica Obliterance through a perineal incision

Sri Lanka Journal of Urology (SLJU) is a peer reviewed, open access journal published annually by the Sri Lanka Association of Urological Surgeons (SLAUS). The Journal commenced in 2000 as the official publication of the SLAUS since its inception in 1999. Full text articles are available.

Outcome of Buccal Mucosal Graft Urethroplasty in Long Segment Anterior Urethral Stricture

Objective: To assess the success of BMG urethroplasty in long segment anterior urethral stricture.&#x0D; Method: From January 2014 to December 2015, twenty male patients with long anterior segment urethral stricture were managed by BMG urethroplasty. After voiding trial they were followed up at 3 month with Uroflowmetry, RGU &amp; MCU and PVR measurement by USG. Patients were further followed up with Uroflowmetry and PVR at 6 months interval.Successful outcome was defined as normal voiding with a maximum flow rate &gt;15ml /sec and PVR&lt;50 ml with consideration of maximum one attempt of OIU after catheter removal.&#x0D; Results: Mean stricture length was 5.2 cm (range 3-9 cm) and mean follow-up was 15.55 months (range 6-23 months). Only two patients developed stricture at proximal anastomotic site during follow-up. One of them voided normally after single attempt of OIU. Other one required second attempt of OIU and was considered as failure (5%).&#x0D; Conclusion: BMG urethroplasty is a simple technique with good surgical outcome.&#x0D; Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.64-68

Outcome of Dorsal Onlay Urethroplasty for Long Segment Anterior Urethral Stricture: Experience of 31 Cases

Objective: To determine the short-term outcome of dorsolateral onlay urethroplasty in the treatment of long segment anterior urethral stricture.&#x0D; Materials and Methods: A prospective study from May 2011 to September 2012 is carried out in department of Urology, National Institute of Kidney Diseases and Urology, Sher-EBanglanagar, Dhaka. Thirty one patients with long anterior urethral stricture were treated by a dorsolateral onlay buccal mucosa graft. After voiding trial, they were followed up at 3 weeks and 3 months with history, physical examination, uroflowmetry and retrograde urethrogram (RGU) if required (uroflowmetry &lt;15 ml/sec). Patients were further followedup at 3 months interval with uroflowmetry and retrograde urethrogram (RGU) if required (uroflowmetry &lt;15 ml/sec). Successful outcome was defined as normal voiding with no surgical intervention after catheter removal.&#x0D; Results: Mean stricture length was 42.49±12.77 mm (range 24-70 mm) and mean follow up was 8 months (range 6 to 12 months). Three patients were found to develop stricture at anastomotic site, during follow-up and required optical internal urethrotomy and was considered as failure. One patient developed wound infection which resolved after regular dressing. Success rate was 90.32%.&#x0D; Conclusion: Dorsolateral onlay BMG urethroplasty is feasible for long anterior urethral stricture with good short term surgical outcome.&#x0D; Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.28-31

Dorsolateral Onlay Urethroplasty for the Long Segment Anterior Urethral Stricture: Outcome of 31 Cases

Objective: This study is designed to observe the short-term outcomes of dorsolateral onlay urethroplasty to treat long segment anterior urethral stricture.&#x0D; Materials and Methods: A prospective study from May 2011 to September 2012 is carried out in department of Urology, National Institute of Kidney Diseases and Urology, Sher-EBanglanagar, Dhaka. Thirty one patients with long anterior urethral stricture were treated by a dorsolateral onlay buccal mucosa graft. After voiding trial, they were followed up at 3 weeks and 3 months with history, physical examination, uroflowmetry and retrograde urethrogram (RGU) if required (uroflowmetry &lt;15 ml/sec). Patients were further followedup at 3 months interval with uroflowmetry and retrograde urethrogram (RGU) if required (uroflowmetry &lt;15 ml/sec). Successful outcome was defined as normal voiding with no surgical intervention after catheter removal.&#x0D; Results: Mean stricture length was 42.49±12.77 mm (range 24-70 mm) and mean follow up was 8 months (range 6 to 12 months). Three patients were found to develop stricture at anastomotic site, during follow-up and required optical internal urethrotomy and was considered as failure. One patient developed wound infection which resolved after regular dressing. Success rate was 90.32%.&#x0D; Conclusion: Dorsolateral onlay BMG urethroplasty is feasible for long anterior urethral stricture with good short term surgical outcome.&#x0D; Bangladesh Journal of Urology, Vol. 18, No. 1, Jan 2015 p.12-15

Comparison of Outcome Between Single Stage Dorsolateral Onlay Buccal Mucosal Graft Urethroplasty and Johanson’s Staged Urethroplasty for Treatment of Long Segment Anterior Urethral Stricture

Background: Urethroplasty is the treatment of choice for long segment anterior urethral stricture. Various types of graft can be used as substitution, but now a day Buccal Mucosal Graft (BMG) is more popular with very promising results. This study was conducted to compare the outcome between dorsolateral free BMG graft and traditional staged reconstruction technique. &#x0D; Materials and methods: This was a hospital based quasi experimental study done prospectively on 64 patients, dividing in two groups, dorsolateral onlay BMG Urethroplasty (Group A) and Johanson’s staged Urethroplasty (Group B) from January 2016 to June 2018 for long segment (3080mm) anterior urethral stricture with a minimum 06 months follow-up. Two patients were failed to attened at follow up clinic were excluded from the study. Data were analyzed by student’s t test, and chi-square test where appropriate. &#x0D; Results: Total 62 patients were included in results (2 lost in follow-up) 32 patients with BMG (Group A) and 30 patients with Johanson’s urethroplasy (Group B) in 6 months follow-up where success rate of group A was 90.7% and group B 63.3% which is statistically significant. At the end of six months 22 patients (68.8%) in Group A had peak urnary flow rate more than 15 ml/sec, whereas only nine patients (33.3%) had had such flow rate in B group. Post operative complications were significantly higher in Group B. Eight patients (26.7%) in Group B had developed fistula and eleven patients (36.7%) had recurrence in Group B which is significantly higher then Group A. &#x0D; Conclusions: Dorsolateral onlay BMG urethroplasty is comparatively an effective technique with excellent functional outcome for long segment an- terior urethral stricture and feasible with good short term success.&#x0D; JCMCTA 2020 ; 31 (1) : 31-37

Single Stage Buccal Graft Urethroplasty for Long Segment Anterior Urethral Strictures: Experience and Outcome From A Tertiary Hospital.

Single Stage Buccal Graft Urethroplasty for Long Segment Anterior Urethral Strictures: Experience and Outcome From A Tertiary Hospital.

Outcome of Dorsolateral OnlAy OMG Urethroplasty for Anterior Urethral Stricture

Objective: To determine the feasibility, safety, efficacy and short term outcome of using new surgical technique for repair of anterior urethral stricture&#x0D; Introduction: The conventional approach for management of long segment anterior urethral stricture is a two stage Johansons repair along with the use of free grafts if required. Now a days the preferred management of urethral stricture involving long segments of anterior urethra is dorsal only oral mucosa Augmentation urethroplasty which requires circumferential mobilization of urthera that might cause ischaemia of urethra in addition of chordee. For that we adopted new technique (kulkarnis) of dorsolateral onlay buccal mucosal graft one sided anterior urethroplasty in which only unilateral urethral mobilization done through perineal approach.&#x0D; Materials and Methods: A total of 50 patients underwent urethroplasty for anterior urethral strictures using dorsolateral onlay BMG from April 2010 to December 2012 at NIKDU, JBFH, BSMMU and BDM Hospital. We selected 16 to 70 years old male (mean age 39 years) underwent a one-sided dorsolateral oral mucosal graft urethroplasty. The mean (range) stricture length was 6.5 (4.5-9) cm in patients with single bulbar urethral involvement and 10.5 (8.5–15.0) cm in patients with panurethral strictures. Free graft was taken from oral mucosa either lower lip or cheeks. Follow up was done by uroflowmetry at 3rd week, after removal of penile catheter and repeat at 3rd and at 6th month. In addition to uroflometry – RGU &amp; MCU was done at 3rd month and Urethrocystoscopy was done at 6th month follow up. The results were classified into the following outcomes. Success was defined as a maximum flow rate of &gt;10 ml/sec, normal RGU, and/or urethroscopy (with a 19 Fr. sheath). Failure was defined as the presence of obstructive urinary tract symptoms, Qmax &lt;10 ml/sec, stricture diagnosed on retrograde urethrogram/ urethroscopy, and the need for any postoperative urethral intervention.&#x0D; Result: The overall follow up was 12-30 months. Of the 50 patients 45 (90%) had a successful outcome and 5(12%) had failure. 3 failure treated by OIU and 2 by meatal dilatation. No significant donor site defect was observed.&#x0D; Bangladesh Journal of Urology, Vol. 16, No. 2, July 2013 p.37-42

Is the Tongue an “Alternative Donor Site for Anterior Urethroplasty”?

Objective: To evaluate the effectiveness of a lingual mucosal graft (LMG) urethroplasty for long segment (&gt;2cm) anterior urethral strictures.&#x0D; Materials and Methods: A total of 30 patients underwent urethroplasty for anterior urethral strictures using dorsal onlay of a LMG from January 2009 to December 2010. We selected 21 to 56 years old (mean age 36.6). Stricture length was 22 to 59 mm (mean 36); 14 strictures were in the bulbar urethra, 09 were in the proximal penile and 07 were in both bulbar and penile urethra. Postoperatively all patients were followed with urethrography, uroflowmetry, cystourethrography and urethroscopy after 3weeks, 3 months and 06 months. Successful reconstruction criteria were peak flow rate greater than 15 ml per second and no need for postoperative urethral dilation.&#x0D; Results: The mean period of follow-up was 9 months (range 4-12). The overall success rate at 3rd week and 3rd month was 96.7% and at 6th month was 90%. Three patients developed repeat stricture at the anastomotic site. All the patients were able to resume oral fluid within 24 h, eat soft solid diet in 48–72 h and return to normal diet after 4– 5 days of surgery. No patient suffered from difficulty in opening the mouth, salivation disturbances, or difficulty in protrusion of tongue.&#x0D; Conclusions: LMG is easy to harvest. LMG seems to be associated with less postoperative pain and a minor risk of donor site complications or without any functional or esthetic deficiency. The tongue may be the best alternative donor site.&#x0D; Bangladesh Journal of Urology, Vol. 15, No. 1, Jan 2012 p.11-14

Treatment of Short Segment Anterior Urethral Stricture: Optical Internal Urethrotomy (OIU) Alone and OIU with Triamcinolone

Optical urethrotomy has been considered standard therapy for anterior urethral stricture since its introduction in 1976. Now optical internal urethrotomy (OIU) with intralesional triamcinolone injection is a safe and effective, minimally invasive therapeutic modality. The aim of the study is to compare the outcome of OIU alone and OIU with intralesional triamcinolone injection in the treatment of anterior urethral stricture. This Quasi Experimental study was carried out among 50 male patients with bulbar urethral stricture in the Department of Urology, Dhaka Medical College Hospital, Dhaka, over a period of six months. The age range of the patients were 32-46 years and patients were divided equally into two groups, OIU with and without intralesional triamcinolone acetonide injection as Group- A (experimental group, 25 patients) and Group- B (control group, 25 patients). Post-operative evaluation was done on the basis of history and uroflowmetry. Retrograde urethrography and micturating cystourethrography were done only in patient who developed obstructive voiding problems or flow rate below 10 ml/second. Follow up was done at regular interval on 7th day, 3rd month and 6th month. Post-operative outcomes were compared between two groups. Post-operative infection was significantly higher among those OIU with intralesional Triamcinolone acetonide injection (8%) than patients without intralesional Triamcinolone acetonide injection (4%). Per operative extravasations of urine were significantly higher among those without intralesional Triamcinolone acetonide injection (4%) than subjects with intralesional Triamcinolone acetonide injection. Extravasation not influenced by steroid but this patient subsequently suffered recurrence of stricture. In Group-A, pre and post-operative Q-max were 10.25±2.21 and 22.11±2.96 ml/sec respectively. In Group-B, pre and post-operative follow up Q-max were 10.37±2.55 and 19.54±2.65 mi/sec respectively. In Group-A, pre and post-operative voiding time was 85.20±4.20 and 27.10±3.36 sec respectively. In Group-B, pre and post-operative follow up voiding time were 86.37±4.55 and 31.45±2.55 sec respectively. Post-operative recurrences of stricture were significantly higher among those without intralesional Triamcinolone acetonide injection (24%) than subjects with intralesional Triamcinolone acetonide injection (12%). Post-operative it seems that triamcinolone injection after OIU is safe method to prevent the recurrence of urethral stricture&#x0D; Bangladesh Med J. 2019 Jan; 48 (1): 31-38

A comparative study between the outcomes of visual internal urethrotomy for short segment anterior urethral strictures done under spinal anesthesia and local anesthesia.

This study is a randomized controlled study comparing the effectiveness and outcomes of direct visual inter urethrotomy (DVIU) for short segment anterior urethral strictures performed under local anesthesia versus spinal anesthesia. Patients presenting with an anterior urethral stricture up to 2 cm were randomized into two interventional groups: Group I-DVIU done under spinal anesthesia and Group II-DVIU performed under local anesthesia. Procedural discomfort was analyzed with a visual analog scale (VAS) immediately postoperatively and after one hour of the procedure. The changes in the vital parameters (systolic blood pressure and pulse rate) were recorded. The success of the procedure was defined as the absence of symptoms of recurrent stricture along with the ability of self-urethral calibration with an 18Fr catheter on follow-up. One hundred and twenty patients, between December 2015 and February 2017, were randomized into the two above-mentioned groups with 60 patients each. The demographic profile, the stricture characteristics (etiology, length, and duration of symptoms), and the preoperative parameters (Qmax, preoperative pulse rate, and systolic blood pressures) were comparable in both the groups. The mean (±SD) intraoperative and one-hour postoperative VAS scores were 1.96 (±1.04) and 1.20 (±0.73), respectively, for Group I, which were significantly less (p<0.05) than the VAS scores 4.26 (± 1.98) and 2.13 (±1.71), respectively, for Group II. The intraoperative mean increases in pulse rate and systolic blood pressure were also significantly lower in Group I (p<0.05). The change in postoperative Qmax (mL/sec) was comparable in both the groups (mean of 20.75±4.31 vs. 19.041 4.88) and so is the stricture free rate at a one-year follow-up. No significant differences in complication rates were observed in both the groups. Although perioperative procedural parameters seem to be in favor of spinal anesthesia, the outcome of DVIU is independent of the type of anesthesia used.

Tissue engineered indigenous pericardial patch urethroplasty: A promising solution to a nagging problem

ObjectiveUrethral stricture is a highly prevalent disease and has a continued rising incidence. The global burden of disease keeps rising as there are significant rates of recurrence with the existing management options with the need for additional repeat procedures. Moreover, the existing treatment options are associated with significant morbidity in the patient. Long segment urethral strictures are most commonly managed by augmentation urethroplasty. We explored the potential for the application of an acellular tissue engineered bovine pericardial patch in augmentation urethroplasty in a series of our patients suffering from urethral stricture disease. The decreased morbidity due to the avoidance of harvest of buccal mucosa, decreased operative time and satisfactory postoperative results make it a promising option for augmentation urethroplasty. MethodsNine patients with long segment anterior urethral strictures (involving penile and/or bulbar urethra and stricture length >4 cm) were included in the study after proper informed consent was obtained. Acellular tissue engineered indigenous bovine pericardial patch was used for urethroplasty using dorsal onlay technique. ResultsA total of nine patients underwent tissue engineered indigenous pericardial patch urethroplasty for long segment urethral strictures, mostly catheter injury induced or associated with balanitis xerotica obliterans. Median follow-up was 8 months (range: 2–12 months). Out of nine patients, eight (88.9%) were classified as success and one (11.1%) was classified as failure. ConclusionOur study brings a product of tissue engineering, already being used in the cardiovascular surgery domain, into the urological surgery operating room with satisfactory results achieved using standard operating techniques of one stage urethroplasty.

Analysis of the donor site complications after long-strip lingual mucosal graft for the treatment of long-segment anterior urethral strictures in males

Objective To analyze the donor site complications of male patients with long segment anterior urethral strictures that underwent urethroplasty by using a long-strip lingual mucosal grafts (LMG) six months later. Methods Between August 2006 and December 2014, a total of 81 patients with long segment anterior urethral stricture underwent a procedure of urethroplasty using a long-strip LMG. The mean patients’ age was 41.2 years (range 18-74) and the mean urethral stricture length was 12.1 cm (range, 8-20 cm), a single LMG was more than 9 cm. Two techniques of urethroplasty were performed: One-sided dorsal graft augmentation urethroplasty was performed in 70 patients, 12 of the 70 patients underwent urethroplasty by using a LMG in addition to a BMG, owing to the presence of very long strictures; Dorsal patch graft urethroplasty was performed in 11 patients. Results Of the 81 patients a single long-strip LMG with length of 9-11 cm was used in 52 patients, LMG measured ≥12 cm in 17, and LMG combined with buccal mucosal graft (BMG) in 12. The mean follow-up period was 41 months (range, 15-86 months) postoperatively. The overall urethroplasty success rate was 82.7%. Six months after the operation, 28 patients (34.6%) reported a minimal to moderate difficulty in fine motor movement of the tongue (difficulty with spitting tiny fish bones). Among these 28, 22 patients (27.2 %) had associated numbness over the donor site, 10 patients (12.3%) had parageusia, and 11 patients (13.6%) reported slurring of speech. The donor site complications occurred higher in patients with LMG length≥12 cm (14/29) than those patients with LMG length<12 cm (14/52)(χ2=19.049, P<0.01). At 12 months, 5 patients (6.2%) reported minimal difficulty in fine motor movement of the tongue, and reduced to 1 patient at 24 months. Conclusions The donor side complications after long-strip lingual mucosal graft for the treatment of long-segment anterior urethral strictures are primarily limited to the first postoperative year, the incidence of complications appeared to be related to the length of the harvested graft. Key words: Lingual mucosa; Complication; Urethral stricture; Urethroplasty

Combined Dorsal and Ventral Buccal Mucosal Graft Urethroplasty by Unilateral Mobilisation of Urethra with Single Dorsal Urethrotomy Incision in Long Segment Anterior Urethral Strictures

The aim of this study is to evaluate the outcomes of combined dorsal and ventral buccal mucosal graft urethroplasty by unilateral mobilisation of urethra with single dorsal urethrotomy incision in long and narrow anterior urethral strictures with preserving the narrow urethral plate and blood supply. Between June 2012 and July 2016, 26 men with long anterior urethral strictures underwent urethroplasty by our technique in a tertiary care teaching hospital. The urethra was mobilised only one side. Then, it was opened in the dorsal midline over the stricture. The first graft was secured on the tunica of the corporal bodies. Thereafter, the diseased mucosa on the ventral side of the urethra was excised and the second graft was placed as ventral inlay and fixed to the corpus spongiosum. The cut edges of urethra were closed by suturing to dorsally placed graft. Successful urethral reconstruction was defined as normal voiding without the need for any postoperative procedure. Mean follow-up was 36 months and mean stricture length was 4.29 cm. Of these 26 cases, 23 (88.4%) were successful and 3 (11.53%) were treatment failures with restricture. The combined dorsal plus ventral buccal mucosal graft urethroplasty by unilateral mobilisation of urethra with single dorsal urethrotomy incision provides adequate urethral augmentation by preserving urethral vascularity and the narrow strip of urethral plate in long and tight anterior urethral strictures.