Ventral Onlay Buccal Mucosal Graft Research Articles

Decision regret and long-term success rates after ventral buccal mucosa graft urethroplasty.

To characterise the long-term success rate of ventral onlay buccal mucosa graft urethroplasty (vBMG) in the management of bulbar urethral stricture disease (USD), assess patient-reported postoperative satisfaction and decision regret, and delineate clinical factors impacting patient-reported metrics. Patients with prior vBMG for bulbar USD, performed at Cleveland Clinic between 2003 and 2022, were contacted and brief structured interviews were performed. Stricture recurrence and need for secondary procedures, baseline demographics, and patient-reported outcome surveys were collected. The surveys included the Decision Regret Scale (DRS), the Urethral Stricture Symptom Impact Measure (USSIM) and the 10-item Patient-Reported Outcomes Measurement Information System Short Form, version 1.2 (PROMIS-10). Descriptive, univariate and multivariable analyses were performed for clinical outcomes and survey responses. A total of 104 patients recorded responses. The median patient age was 49 years and the median follow-up was 7.4 years at time of survey. The median graft length was 5 cm and 38% of patients underwent partial thickness augmented anastomotic urethroplasty. At time of follow-up, 10 patients underwent a secondary procedure. Moderate to severe regret on the DRS was found in 12% of patients, and greater regret was associated with recurrence. The mean physical and mental health PROMIS-10 Global Health T-scores were 52 and 53. The mean total USSIM score was 56. A significant correlation was found between USSIM and DRS scores, with higher DRS score and recurrence negatively impacting USSIM score. USSIM scoring across all domains was significantly worse in the moderate to severe DRS group. This study showed that vBMG for bulbar USD confers both high success rates and patient-reported satisfaction at extended follow-up, based on emerging and validated patient-reported outcome measures.

Ventral Onlay Buccal Mucosa Graft Urethroplasty for Female Urethral Stricture: Medium-term Results in a Single Surgeon Experience

ObjectiveTo describe our own approach using buccal mucosal grafting and to assess the outcome of this approach. Materials and MethodsA total of 42 patients underwent ventral onlay BMG by a single surgeon between 2017 and 2022. A longitudinal incision along the length of the urethra was made through the anterior vaginal wall and the peri-urethral fascia was incised to create two flaps. This ventral urethrotomy ran from the meatus into the proximal health urethra above the level of the stricture.A buccal mucosal graft was harvested and sutured to the margins of the urethral mucosa itself and the flaps of peri-urethral fascia. The vaginal wall was then closed. ResultsThe mean age of the patients was 53.6 ± 12.8 years. There were no perioperative or postoperative complications. At a mean follow-up of 38.1 months, 41 patients (98%) were stricture-free. Peak flow rate improved from a mean of 7.7 ± 3.2 ml/s preoperatively to 25.9 ± 5.9 ml/s postoperatively. No patient developed incontinence. One patient developed a recurrent urethral stricture which was treated by redo urethroplasty. ConclusionsThe surgical technique applied has proved efficiency. The ventral BMG preserves the urethral sphincter and so avoids postoperative incontinence. The use of peri-urethral fascia represents a good vascular and mechanical support for the graft.

Outcomes of Ventral Onlay Buccal Mucosal Graft Urethroplasty in Bulbomembranous Urethral Strictures Post-transurethral Resection of the Prostate

ObjectivesTo evaluate the outcomes of Ventral Onlay Buccal Mucosal Graft Urethroplasty (VOBMGU) in bulbomembranous urethral strictures after transurethral resection of the prostate (TURP). MethodsAfter approval of the institutional ethical committee, we retrospectively examined the database of patients diagnosed with PTS and treated by VOBMGU from January 2020 to January 2022. The patients were evaluated by retrograde urethrogram (RUG) and voiding cystourethrogram (VCUG). Follow-up evaluation included assessment of lower urinary tract symptoms (LUTS), physical examination, uroflowmetry (Q-max and International Prostate Symptom Score) 3, 6, and 12 months of follow-up. ResultsA total of 30 patients underwent VOBMGU for bulbomembranous PTS were included. The median age of the patients was 63.5 (11.25). The median stricture length was 3.5 (1.5) cm. During follow-up, the mean Q-max significantly increased to 21.1 ± 5.5 ml/s (p < 0.0001), 20.1 ± 5.4 ml/s (p<0.001), and 19.1 ± 5.3 ml/s (p<0.003) at 3, 6, and 12 months respectively. IPSS significantly decreased to 8.93 ± 6.37 at the 12-month follow-up mark (p<0.0001). Three patients developed stricture recurrence and two patients developed post-operative urinary incontinence. ConclusionVOBMGU in cases of bulbomembranous urethral PTS offered excellent functional outcomes with low stricture recurrence and minimal risk of incontinence. Further prospective studies are warranted to confirm the results.

Female ventral-onlay buccal mucosal graft urethroplasty supported with martius labial fat pad flap: early results.

There is a growing interest in reconstructive urology and female urethroplasty. We aimed to report our experience in ventral-onlay buccal mucosa graft (BMG) urethroplasty supported with Martius flap (MF) in treating female urethral stricture disease. We retrospectively evaluated data of 18 female patients (ages 35-78) who were diagnosed with urethral stricture disease and underwent ventral-onlay BMG urethroplasty supported with MF by single surgeon in a tertiary referral centre between February 2019 and October 2022. Detailed history, international prostate symptom score (IPSS), pelvic examination, urine flow rate (rate and pattern), post void residual (PVR), storage and voiding phase urodynamic study, and voiding cystourethrography were recorded. At the last visit; the number of urethral dilatations before urethroplasty, time from urethral dilation to urethroplasty, hospital stay, urethral catheterization time, postoperative IPSS, PVR and uroflowmetry values were recorded. The presenting symptoms were obstructive voiding symptoms in 16 patients. While the mean number of urethral dilatation was 2.11 ± 1.93 (1-7), the mean time from dilatation to urethroplasty was 5.83 ± 5.00 (1-19months) months. Maximum flow rate increased from 8.36 ± 3.26ml/sec in preoperative uroflowmetry to 21.45 ± 5.27ml/sec at the last follow-up (p < 0.001). Post-void residual urine (PVR) decreased from preoperative mean 116.66 ± 105.88cc to 26.94 ± 22.69cc postoperatively (p < 0.004). None of the patients developed stricture recurrence, incontinence or vaginal fistula until the last follow-up. The mean follow-up period was 17.28 ± 11.65 (1-35) months. A ventral-onlay BMG urethroplasty supported with MF represents an effective and reproducible treatment option for FUS in the present study.

A Comparative Study of the Outcome of Dorsolateral and Ventral Onlay Buccal Mucosal Graft Urethroplasty for Long Segment Bulbar Urethral Stricture

Background: Urethral strictures pose a significant challenge in urological practice, and substitution urethroplasty using a buccal mucosal graft is a widely accepted surgical technique. However, the optimal placement of the graft, whether dorsal onlay, ventral onlay or dorsolateral onlay is still unresolved. This study aimed to compare the outcomes of dorsolateral and ventral onlay buccal mucosal graft urethroplasty for long-segment bulbar urethral strictures. Methods: A prospective, quasi-experimental study was conducted at the Department of Urology, Dhaka Medical College Hospital, from July 2018 to September 2019. Fifty patients with long-segment bulbar urethral strictures were equally divided into two groups: Group-A (dorsolateral onlay) and Group B (ventral onlay). Patients were followed up for six months, and the groups were compared based on the International Prostate Symptom Score (IPSS), quality of life, maximum flow rate (Qmax), findings of retrograde urethrogram and voiding cystourethrogram, urethroscopic findings, complications and success rate. Results: Preoperative stricture lengths in Group-A and Group B were 3.62 ± 0.46 cm and 3.42 ± 0.54 cm respectively. Mean IPSS improved in both groups after surgery, with no significant difference between them. Mean Qmax also improved in both groups, with no significant difference between them. Success rates were 88% and 84% in Group-A and Group B respectively. Complications included wound hematoma, wound infection, and urethral diverticulum, while urethrocutaneous fistula and erectile dysfunction were not observed. Stricture recurrence rates were 12% in Group-A and 16% in Group B. Overall, both techniques demonstrated similar effectiveness and outcomes. Conclusion: Dorsolateral and ventral onlay buccal mucosal graft urethroplasty techniques yielded favourable short-term outcomes with low complication rates for long-segment bulbar urethral strictures. Both approaches were equally effective in terms of success ...

Ventral onlay buccal mucosa graft urethroplasty for female urethral stricture improves female sexual functions.

Female urethroplasty provides excellent results with high success rates in the treatment of female urethral stricture (FUS), but sexual functions after urethroplasty is another concern and have not been adequately investigated. We aimed to evaluate changes in the sexual functions of patients undergoing ventral onlay buccal mucosa graft urethroplasty (VOBMGU). We retrospectively evaluated 18 patients who underwent VOBMGU supported with a Martius labial fat pad flap (MLFPF) in our tertiary referral centre, between 2019 and 2021. After excluding patients who were sexually inactive and those with missing postoperative data, 13 patients were included. Surgical outcomes were assessed with uroflowmetry, the American Urological Association symptom score (AUA-SS), and Urogenital Distress Inventory (UDI)-6. Short Form-36 (SF-36) was used to evaluate the quality of life (QoL). Sexual function was assessed using the Female Sexual Function Index (FSFI) both preoperatively and at 6 months following surgery. The median age was 50 (IQR:44-62) years. There was no surgical failure, and none of the patients developed incontinence or stricture recurrence during a median follow-up of 30 (IQR:12-30) months. The median maximum flow rate increased from 9.2 (IQR:5-11.5) to 19 (IQR:17.35-27.10) ml/s (p = 0.001), the median post-void residual (PVR) volume decreased from 80 (IQR:0-205) to 20 (IQR:10-45) ml (p = 0.021), the median AUA-SS decreased from 19 (IQR:14-22) to 6 (IQR:4-8) (p = 0.001), and the median UDI-6 score decreased from 12 (IQR:6.5-16) to 4 (IQR:2-9) (p = 0.008) postoperatively. Bodily pain and general health perception domains and the physical component summary score were significantly improved in the SF-36 (p = 0.015, 0.022, and 0.009, respectively). The median total FSFI score increased from 17.40 (IQR:1.95-23.65) to 22.60 (IQR:5-24.95) postoperatively (p = 0.004). Improvements were observed in all domains (p < 0.05) except the arousal (p = 0.058) and pain (p = 0.104) domains of the FSFI. We concluded that VOBMGU has good early functional results and improves female sexual function.

Urethroplasty Outcomes for Pars Fixa Urethral Strictures Following Gender-affirming Phalloplasty and Metoidioplasty: A Retrospective Study

To evaluate outcomes of three urethroplasty techniques for pars fixa (PF) urethral strictures and provide a treatment algorithm based on stricture characteristics. The PF is an essential anatomic region of the neourethra created in gender-affirming phalloplasty and metoidioplasty. Urethral strictures in this region present a reparative challenge given its unique anatomy and vascularization. A total of 41 urethroplasties performed on 41 patients between March 2018 and June 2021 were reviewed at two surgical centers. A Heineke-Mikulicz (HM) repair was done for strictures under 20 mm when the proximal and distal urethral segments were mobile and supported a tension-free closure. Substitution urethroplasty with ventral onlay buccal mucosal graft was utilized for strictures under 40 mm not suitable for HM repair. Complex or long (≥40 mm) strictures were treated by two-stage Johansen urethroplasty. Success of each surgical approach was defined by a minimum of 12-month follow-up without the need for a repeat intervention. Mean follow-up was 30.2 months (range: 12.4-52.0 months). Mean stricture length was 16.9 mm (range: 2-55 mm). Most strictures (46%) were located at the distal PF. HM urethroplasty had a success rate of 44% (n = 16). Substitution urethroplasty had a success rate of 92% (n = 13). Two-stage Johansen urethroplasty had a success rate of 75% (n = 12). The success rates of PF urethral stricture repair ranged from 44% to 92% depending on the surgical approach, and the best reparative procedure depends on stricture length, severity, and local tissue mobility.

41 - Ventral onlay buccal mucosa graft urethroplasty for female urethral stricture: Medium-term results in our referral center

41 - Ventral onlay buccal mucosa graft urethroplasty for female urethral stricture: Medium-term results in our referral center

MP74-01 CHARACTERISATION OF FEMALE URETHRAL STRICTURES

You have accessJournal of UrologyCME1 Apr 2023MP74-01 CHARACTERISATION OF FEMALE URETHRAL STRICTURES Elizabeth Day, Helena Gresty, Anthony Noah, Richard Nobrega, Jeremy Ockrim, and Tamsin Greenwell Elizabeth DayElizabeth Day More articles by this author , Helena GrestyHelena Gresty More articles by this author , Anthony NoahAnthony Noah More articles by this author , Richard NobregaRichard Nobrega More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , and Tamsin GreenwellTamsin Greenwell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female urethral stricture (FUS) is rare. We have assessed the history, imaging and urodynamic characteristics of all women seeking urethroplasty for recurrent symptomatic strictures. METHODS: A retrospective review of 63 consecutive women (median age 50.5 years, range 25-71) with recurrent or refractory FUS undergoing urethroplasty since June 2012. Data was analysed for symptom profile, aetiology and previous therapy. MRI, videourodynamic (VUDS) and examination findings provided stricture length and site. RESULTS: Median duration of symptoms was 60 months (range 24-456). The commonest symptoms were poor flow 61 (97%), frequency 48 (76%), nocturia 46 (73%), urgency 44 (70%), recurrent UTI 41 (65%) and urethral pain 40 (63%). The commonest causes of FUS are, unknown in 37 (59.7%), urethral instrumentation/catheterisation in 7 (11.1%), urethral diverticulum excision in 4 (6%), radiotherapy in 3 (4.7%), none relaxing sphincter in 3 (4.7%) and lichen planus in 2 (3.2%). The women had had a median of 5 previous urethral dilatations (range 0-33). 38 (60%) had been performing ISC for a mean of 24 months (range 6-120) and 31 (82%) found it painful. Pre-operative MRI pelvis was performed in 56 (89%) and revealed a concentrically thickened urethra in 35 (63%), urethral diverticulum in 4 (6%), an absent/fibrotic urethra in 4 (6%), and no abnormalities in 13 (21%). Pre-operative VUDS were performed in 57 (90%). Bladder outflow obstruction (BOO) was seen in 56 (98%). Preoperatively median Qmax was 5 mls/s (range 0-24), median Pdet Q max was 70 cm H2O (range 0-165) and median Solomon-Greenwell BOOIf was 51.4 (range -24.2-156.2) (where BOOIf >5 =>50% chance of BOO). Other findings included detrusor overactivity in 22 (39%) and stress urinary incontinence in 7 (12%).Median stricture length was 2.0 cm (range 0.5-4.0 cm) and the commonest sites were mid-distal in 20 (32%) and distal in 19 (30%). 53 (84%) had ventral onlay buccal mucosal graft urethroplasty, 6 (10%) had ventral vaginal flap urethroplasty, 2 (3%) had ventral onlay labial minora flap urethroplasty and 1 (1.5%) had a ventral vaginal graft urethroplasty – with stricture free status in 55 (87%) at last follow-up (median 39 months, range 4-112). CONCLUSIONS: Poor flow is present in almost all women with FUS. The majority will also have irritative LUTS, recurrent UTIs and urethral pain. VUDS and MRI are useful pre-operatively to characterise the stricture. Definitive treatment with urethroplasty should be considered earlier once endoscopic management has failed. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1069 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Day More articles by this author Helena Gresty More articles by this author Anthony Noah More articles by this author Richard Nobrega More articles by this author Jeremy Ockrim More articles by this author Tamsin Greenwell More articles by this author Expand All Advertisement PDF downloadLoading ...

MP74-02 MEDIUM TO LONG-TERM OUTCOMES OF VENTRAL-ONLAY BUCCAL MUCOSA GRAFT SUBSTITUTION URETHROPLASTY FOR FEMALE URETHRAL STRICTURE

You have accessJournal of UrologyCME1 Apr 2023MP74-02 MEDIUM TO LONG-TERM OUTCOMES OF VENTRAL-ONLAY BUCCAL MUCOSA GRAFT SUBSTITUTION URETHROPLASTY FOR FEMALE URETHRAL STRICTURE Elizabeth Day, Helena Gresty, Anthony Noah, Richard Nobrega, Jeremy Ockrim, and Tamsin Greenwell Elizabeth DayElizabeth Day More articles by this author , Helena GrestyHelena Gresty More articles by this author , Anthony NoahAnthony Noah More articles by this author , Richard NobregaRichard Nobrega More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , and Tamsin GreenwellTamsin Greenwell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female urethral stricture (FUS) is rare. Urethroplasty is becoming increasingly popular however there is little to guide choice of technique as all series to date contain small numbers with limited follow-up. We report the medium to long-term outcomes of ventral-onlay buccal mucosa graft substitution urethroplasty (VOBMGSU) in treating FUS. METHODS: A retrospective review of a prospectively acquired database of 52 consecutive women (median age 51 years, range 31-71) with urethral stricture having VOBMGSU since June 2012 and a median follow up 38.2 months, range 8.1-111.9). Data was analysed for stricture recurrence, change in peak free flow rate (Qmax), post-void residuals (PVR) and Patient Global Impression of Improvement (PGII) using a 7-point Likert scale where 1=very much better and 7=very much worse). Short and longer-term complications of surgery were noted. Persistent or de-novo lower urinary tract symptoms (LUTS) were investigated to delineate their cause – and this is detailed. Statistical analysis was performed with the Wilcoxon signed rank test, Students T Test and Mann-Whitney U Test. RESULTS: At last follow-up 46/52 (88.5%) of women were stricture free. Mean Qmax significantly improved from 6 ml/s (range 0-24) to 14 ml/s (range 5-31) (p<0.05). Mean PVR significantly reduced from 112 mls (range 0-609) to 38 mls (range 9-86) (p<0.05). Short and longer-term complication rates were low. 1/48 (2.1%) patients developed mild de novo SUI, which settled with conservative measures by 6 months post urethroplasty. Frequency persisted in 6/52 (9.7%) and was managed with intravesical Botox in 2 and Sacral Neuromodulation in 1. Stricture recurrence was managed by meatotomy in 1, meatal dilatation in 2, redo-VOBMG urethroplasty in 2 and vaginal flap meatoplasty in 1 with resolution of stricture in 5. Median PGII at 12 months post VOBMG urethroplasty was 1 (1-4) and this was maintained at 36 months post-surgery. CONCLUSIONS: Medium term results in the largest series of VOBMG female urethroplasty to date are excellent with stricture free rates of 88.5%, median PGII of 1 and significantly improved Qmax and PVRs. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1069 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Day More articles by this author Helena Gresty More articles by this author Anthony Noah More articles by this author Richard Nobrega More articles by this author Jeremy Ockrim More articles by this author Tamsin Greenwell More articles by this author Expand All Advertisement PDF downloadLoading ...

Ventral onlay buccal mucosa graft for female urethral stricture: Medium-term results in our referral center

Ventral onlay buccal mucosa graft for female urethral stricture: Medium-term results in our referral center

Erectile and voiding function outcomes after buccal mucosa graft urethroplasty for long-segment bulbar urethral stricture: ventral versus dorsal onlay technique.

To compare the impact of dorsal versus ventral onlay buccal mucosa graft bulbar urethroplasty on postoperative erectile function status. We retrospectively reviewed the records for 232 patients who underwent dorsal and ventral onlay buccal mucosa graft bulbar urethroplasty from March 2012 to April 2021. Outcomes were urinary and erectile function status as assessed by IIEF5-15 score at preoperative, three months, and 12months post-urethroplasty. We compared the dorsal and ventral only techniques at the different follow-up visits using difference-in-differences analysis. 165 patients met our inclusion criteria; the overall success rate was 87.9% after a mean follow-up of 52.3 ± 18.5months. Of the patients, 17.6% experienced a 90-day complication. When comparing dorsal and ventral only techniques, there were no significant differences in terms of success rate (88.3% vs. 87.1%, Mantel-Cox test p = 0.68) or postoperative complications (15.5% Vs. 19.4%, p = 0.3). Likewise, there was no significant difference between both techniques regarding postoperative erectile function as assessed by IIEF5-15 score after three months (26.28 ± 2.53 Vs. 26.37 ± 2.41; p = 0.836) and twelve months (26.88 ± 2.45 Vs. 26.48 ± 1.98; p = 0.532). We detected a post-urethroplasty transient ED in (3.9% vs. 1.6%; p = 0.41), and permanent ED in (1.9% vs. 3.2%; p = 0.6) for dorsal and ventral onlay, respectively. Onlay Buccal mucosa graft urethroplasty is a highly effective surgery in treating long-segment bulbar urethral stricture. The dorsal and ventral only techniques were comparable regarding urinary and erectile function outcomes. Additionally, both techniques have no significant negative impact on post-urethroplasty erectile function status.

Optimizing decision-making after ventral onlay buccal mucosa graft urethroplasty failure.

To evaluate factors predicting recurrence after treatment and to assess the best rescue option for patients failing buccal mucosa graft (BMG) urethroplasty. We evaluated the data from 575 patients treated with ventral onlay BMG urethroplasty. Multivariable Cox regression analysis was performed to identify predictors of BMG urethroplasty failure, and their effect on failure risk was estimated using the Kaplan-Meier method and compared using log-rank tests. Then, for those patients who underwent a rescue treatment, namely, direct visual internal urethrotomy (DVIU) vs open urethroplasty, we assessed the probability of success after retreatment using the Kaplan-Meier method and regression tree analyses. On multivariable Cox regression analysis, only stricture length ≥5 cm (hazard ratio 3.46, 95% confidence interval 1.50-7.94; P = 0.003) was a predictor of failure. A total of 103 patients had at least one re-intervention. Notably, 12-month success rates after first rescue DVIU, second rescue DVIU, third rescue DVIU, and fourth rescue DVIU were 66.3%, 62.5%, 37.5% and 25%, respectively. Conversely, for those patients who underwent open urethroplasty retreatment, success rates at 12 months were 83.3%, 79%, 92.3% and 75% after BMG ventral onlay, first rescue DVIU, second rescue DVIU and third rescue DVIU, respectively. These data were confirmed in regression tree analyses. Ventral BMG urethroplasty fails in approximately one out of five patients. Despite DVIU as a rescue treatment being a good option, its success rate becomes lower as the number of DVIU treatments performed increases. Conversely, open urethroplasty improves patient outcomes in almost three out of four patients, even in the case of previous failed DVIU treatments for stricture recurrence.

Outcomes of ventral buccal mucosal graft urethroplasty: Our experience at tertiary care hospital.

Objective: To evaluate the outcomes of ventral buccal mucosal graft urethroplasty at tertiary care. Study Design: Case Control Study. Setting: Department of Urology, CMC/SMBBMU Larkana. Period: January 2018 to December 2018. Material &amp; Methods: 50 patients with confidence interval of 95% and margin of error 5% Non-probability consecutive. All Data collected from record like age, stricture size, clinical presentation and routine investigation, Blood CP, ESR, urine culture and X-Ray retrograde urethrogram for proper diagnosis in all cases. Results: The mean age of patients was 35.2 years SD±15.25 years and Mean duration of symptoms was 14.7 month SD±9.98 month. Out of 50 cases of ventral onlay buccal mucosal graft urethroplasties, success rate was (90%). The main complication was transient swelling with altered sensation of lip in 3 cases (6%), 1 case (2%) with recurrent stricture at the site of proximal anastomosis, that was treated by direct vision internal urethrotomy. 1 case (2%) presented with impacted urethral stone that was removed endoscopically. Conclusion: Ventral buccal mucosa grafting urethroplasty give good results in long term with low rate of complications occurring mainly in first year postoperatively.

A0864 - Female ventral-onlay buccal mucosa graft urethroplasty supported with Martius labial fat pad flap: Our early results

A0864 - Female ventral-onlay buccal mucosa graft urethroplasty supported with Martius labial fat pad flap: Our early results

PROSPECTIVE COMPARATIVE STUDY ON OUTCOMES OF VENTRAL ONLAY BUCCAL MUCOSAL GRAFT URETHROPLASTY WITH OR WITHOUT FIBRIN GLUE.

Objectives: We described the use of brin glue in ventral onlay Buccal Mucosal Graft Urethroplasty (BMGU) in patients of bulbar urethral stricture and compared the outcome without brin glue. Methods: Sixty patients underwent bulbar urethroplasty with ventral onlay buccal mucosal graft and were included in this study. They were divided into 2 groups with 30 in each with group 1 with brin glue and group 2 without brin glue. The urethra was mobilized from the corpora cavernosa and opened along its ventral surface. The buccal mucosal graft was applied in the standard ventral onlay technique. Intraoperative evaluation included the lengths of surgery, stricture, and admission. Patients were followed up at 3 and 6 months in the outpatient department and primary outcome measures, that is, IPSS and Qmax were recorded at each follow-up along with complications if any. Results: No signicant difference was observed in mean lengths of surgery, stricture and admission, and distribution of pre-op IPSS and Qmax between the two groups. While a signicant difference was observed in distribution of IPSS and Qmax between the two groups at 3 months and 6 months follow-up. Distribution of early complications was observed at 3 weeks follow-up after surgery with a peri catheter RGU in both groups. 3 patients were presented with a leak in group 1 and 4 patients in group 2. At 3 months 2 patients were showing complications while at 6 months follow-up only 1 patient was showing complications in each group. Conclusions: The use of brin glue represents a slight but signicant step toward the perfection of the surgical technique of bulbar urethral reconstruction.

MP56-19 PROMISING PRELIMINARY RESULTS FOR VENTRAL ONLAY BUCCAL MUCOSAL GRAFT URETHROPLASTY IN FOSSA NAVICULARIS STRICTURES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-19 PROMISING PRELIMINARY RESULTS FOR VENTRAL ONLAY BUCCAL MUCOSAL GRAFT URETHROPLASTY IN FOSSA NAVICULARIS STRICTURES Alejandra Perez, Adam Nolte, Chase Mallory, Scott Jamieson, Jessica Boyer, Dhaval Jivanji, Spencer Liem, George Wayne, and Billy Cordon Alejandra PerezAlejandra Perez More articles by this author , Adam NolteAdam Nolte More articles by this author , Chase MalloryChase Mallory More articles by this author , Scott JamiesonScott Jamieson More articles by this author , Jessica BoyerJessica Boyer More articles by this author , Dhaval JivanjiDhaval Jivanji More articles by this author , Spencer LiemSpencer Liem More articles by this author , George WayneGeorge Wayne More articles by this author , and Billy CordonBilly Cordon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nearly twenty percent of all anterior urethral strictures occur at the fossa navicularis (FN). Management balances restoring urethral patency while maintaining adequate cosmesis. Historically, FN strictures are often managed via glans cap or glans wings, and in severe cases, multi-stage procedures. Augmentation with ventral onlay buccal mucosal grafts (VOBMG) has been traditionally discouraged for fear of poor graft support and risk of fistula formation. METHODS: We retrospectively reviewed clinical and procedural characteristics for all patients with FN strictures that underwent urethroplasty at our institution from August 2016 through February 2021. Our approach included a ventral incision from the meatus to corona leaving a dorsal strip of native urethra to which BMG graft is anastomosed over a 20-24F catheter. A glansplasty is then performed to support the graft. Outcomes included recurrence rates and complication rates. RESULTS: We identified 14 patients that underwent urethroplasty for isolated fossa navicularis strictures. Of these, 9 underwent a single stage VOBMG urethroplasty. Other approaches included staged Johansson repair, mucosal advancement, and fasciocutaneous flaps with glans cap, which were excluded from analysis. Average follow up period to date was 25.8 months. 1/9 (11%) developed a stricture recurrence requiring intervention with balloon dilation, after which there has been no further recurrence at 20 months follow-up. No UTIs, fistulae, or other complications were seen. CONCLUSIONS: Our research demonstrates that single-stage VOBMG is an effective means of treating FN strictures. Despite a limited number of cases, our series demonstrates promising short-term safety and efficacy for this procedure, carrying significant advantages over dilation and staged reconstruction. We observed good graft take, successful cosmetic and functional outcomes and no evidence of urethra-cutaneous fistulas. Further series follow-up and comparative data will help to elucidate durability of outcome and refine treatment options. Source of Funding: n/a © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e976-e976 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alejandra Perez More articles by this author Adam Nolte More articles by this author Chase Mallory More articles by this author Scott Jamieson More articles by this author Jessica Boyer More articles by this author Dhaval Jivanji More articles by this author Spencer Liem More articles by this author George Wayne More articles by this author Billy Cordon More articles by this author Expand All Advertisement Loading ...

PD22-06 A MODIFIED APPROACH TO MEDIUM-LENGTH OBLITERATIVE BULBAR STRICTURES: TECHNIQUE AND OUTCOMES OF THE MUCOMUCOSAL ANASTOMOTIC NON-TRANSECTING AUGMENTATION (MANTA) URETHROPLASTY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II (PD22)1 Sep 2021PD22-06 A MODIFIED APPROACH TO MEDIUM-LENGTH OBLITERATIVE BULBAR STRICTURES: TECHNIQUE AND OUTCOMES OF THE MUCOMUCOSAL ANASTOMOTIC NON-TRANSECTING AUGMENTATION (MANTA) URETHROPLASTY Phillip Marks, Roland Dahlem, Maryam Khonsari, Lennart Kühnke, Frederik König, Margit Fisch, and Malte W. Vetterlein Phillip MarksPhillip Marks More articles by this author , Roland DahlemRoland Dahlem More articles by this author , Maryam KhonsariMaryam Khonsari More articles by this author , Lennart KühnkeLennart Kühnke More articles by this author , Frederik KönigFrederik König More articles by this author , Margit FischMargit Fisch More articles by this author , and Malte W. VetterleinMalte W. Vetterlein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002011.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For short and obliterative bulbar strictures, non-transecting excision and primary anastomosis (EPA) has come of age to avoid disrupting spongiosal blood flow. Longer obliterative strictures may be treated by a combined "double" ventral + dorsal graft (Palminteri et al. 2008) or an augmented anastomotic approach, which was recently refined by a non-transecting technique combining EPA and a dorsal graft (Welk et al. 2012; Bugeja et al. 2016). We here present the initial experience with our ventral modification of this technique, the mucomucosal anastomotic non-transecting augmentation (MANTA) urethroplasty. METHODS: We included patients with an obliterative bulbar segment (≤2 cm) and mild to moderate spongiofibrosis undergoing MANTA between 2016-2019. The stricture is approached by ventral stricturotomy to avoid extensive urethral dissection and mobilization from the corpora cavernosa. Dorsally, the scar is superficially excised and the spongiosum is left intact. Dorsal mucomucosal anastomosis (excluding sponge tissue) is performed, which is complemented by a ventral onlay buccal mucosal graft. Perioperative characteristics were prospectively collected including uroflowmetry data and validated PROMs (6-item LUTS score of the USS PROM). We evaluated the postoperative improvement of objective (uroflowmetry at three weeks postoperatively) and functional follow-up, which incorporated patient-reported parameters (LUTS score) and functional success, whereas recurrence was defined as the symptomatic need of any re-intervention. RESULTS: Median age in 54 men undergoing MANTA was 51 yr, 83% and 26% had a history of ≥1 urethrotomy and urethroplasty, respectively. Stricture location was bulbar in 70% and penobulbar in 30%. Median operative time and graft length was 55 min and 4 cm, respectively. In 35 patients with measurable uroflowmetry data, median Qmax significantly improved (7.7 ml/s preoperatively to 31 ml/s three weeks postoperatively; p<0.001). Cross-sectional functional follow-up was performed at a median of 40 mo (range 5-57) postoperatively and was available in 50/54 patients (93% response rate). Preoperative median 6-item LUTS score was 12 (IQR 8–14) and improved significantly after surgery to a postoperative median of 1 (IQR 0-3; p<0.001). Overall success was 93% with 4/54 patients suffering from functional stricture recurrence and the need of a re-intervention. CONCLUSIONS: MANTA urethroplasty using a ventral onlay provides excellent mid-term results in patients with bulbar strictures with an obliterative segment ≤2 cm and adds to the surgical armamentarium of non-transecting techniques by minimizing extensive mobilization. Source of Funding: n/a © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e382-e382 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Phillip Marks More articles by this author Roland Dahlem More articles by this author Maryam Khonsari More articles by this author Lennart Kühnke More articles by this author Frederik König More articles by this author Margit Fisch More articles by this author Malte W. Vetterlein More articles by this author Expand All Advertisement Loading ...

P0398 - Medium term outcomes of ventral onlay buccal mucosal graft female urethroplasty

P0398 - Medium term outcomes of ventral onlay buccal mucosal graft female urethroplasty

Ventral onlay buccal mucosa graft urethroplasty for female urethral stricture.

Female urethral stricture is a rare disease. Urethroplasty with different techniques using grafts or flaps are successful treatment options. The objective of this study was to present our experience with ventral onlay buccal mucosa graft urethroplasty for the treatment of female urethral stricture disease. Eight female patients treated with ventral onlay buccal mucosa graft urethroplasty were identified retrospectively. Patient evaluation included physical examination, uroflowmetry with postvoid residual urine measurement, videourodynamics and urethrocystoscopy. Stricture was identified by videourethrography and/or urethrocystoscopy. Urodynamic evidence of stricture was considered as a persistent low maximum flow rate of <12mL/s combined with detrusor pressure at maximum measured flow rate of >20cmH2 O in the pressure flow study. The mean age was 50.5±4.14years. Stricture etiology was idiopathic (62.5%) or iatrogenic (37.5%). Two patients (25%) had undergone prior urethral dilations before buccal mucosa graft urethroplasty. Mean stricture length was 1.62±0.44 cm. Stricture location was as follows: four distal urethra (50%), two mid-distal (25%) and two mid-urethra (25%). The mean postoperative follow-up period was 16.37±5.75months, and the during follow-up success rate was 100%. No complication, such as incontinence or vaginal fistula, was noted, except dyspareunia developed in one patient (12.5%). Ventral onlay buccal mucosa graft urethroplasty is a safe and effective treatment option for female urethral stricture. Unnecessary dilation should not be carried out and buccal mucosa graft urethroplasty in expert centers should be recommended to these patients.