You have accessJournal of UrologyCME1 Apr 2023V08-09 TRANSURETHRAL DORSAL BUCCAL GRAFT URETHROPLASTY FOR PROXIMAL FEMALE URETHRAL STRICTURES Francis Jefferson, Jonathan Warner, Maraika Robinson, and Brian Linder Francis JeffersonFrancis Jefferson More articles by this author , Jonathan WarnerJonathan Warner More articles by this author , Maraika RobinsonMaraika Robinson More articles by this author , and Brian LinderBrian Linder More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Treatment options for proximal female urethral strictures have significant limitations such as high recurrence rate (urethral dilation) and de novo stress urinary incontinence (flap/graft reconstruction). The objective of this video was to describe a novel dorsal inlay buccal graft urethroplasty technique that reduces technical difficulty and eliminates the need for urethral mobilization. METHODS: Stay sutures are placed at the urethral meatus, and a nasal speculum is placed into the urethra staying distal to the stricture. A beaver blade is then used to incise the urethra at the 12 o'clock, 10 o’clock, and 2 o’clock positions; these are superficial, non-full thickness incisions. A laparoscopic suture passing device is then used to pass a suture from the bladder to the urethral lumen at the 12:00 o'clock position. The suture is then passed through corresponding mid portion of the buccal graft ensuring that the mucosal side will be in the urethral lumen when the graft is deployed. This is repeated at the 10 o'clock and 2 o'clock positions with placement of the proximal suture at the level of the bladder neck and then through the corresponding location on the buccal graft. The graft is then parachuted into position at the level of the bladder neck. A laparoscopic knot pusher is then used to tie down the proximal sutures through the urethra. After trimming the excess buccal graft flush with the meatus, the distal aspect of the graft is sutured to the vaginal epithelium to recreate the urethral meatus. A wide-bore catheter is placed for 3 weeks postoperatively. RESULTS: In 6 consecutive patients treated with this technique with a median follow-up of 3.9 months, surgical success has been 100% as indicated by urethral patency on cystourethroscopy and subjective symptom improvement. There have been no cases of de novo stress urinary incontinence. Pre- and post-operative maximum urine flow rate (Qmax) and post-void residual volumes (PVR) are shown in the table. CONCLUSIONS: A transurethral inlay approach for dorsal buccal graft placement is a feasible option for management of female proximal urethral structure. Given decreased periurethral dissection compared to other techniques, this approach may decrease the risk of de novo stress urinary incontinence. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e751 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francis Jefferson More articles by this author Jonathan Warner More articles by this author Maraika Robinson More articles by this author Brian Linder More articles by this author Expand All Advertisement PDF downloadLoading ...