Reconstruction of Distal Urethral Strictures Confined to the Glans With Circular Buccal Mucosa Graft

Department of Urology, Bezmi Alem Vakıf University Hospital, Istanbul, Turkey.
Urology (Impact Factor: 2.19). 03/2012; 79(5):1158-62. DOI: 10.1016/j.urology.2012.01.046
Source: PubMed

ABSTRACT To report our results with 1-stage reconstruction in short distal urethral strictures using circular buccal mucosa graft (cBMG).
The data of 19 patients (median age 41.8 years, range 25-58) operated between 2001 and 2010 were reviewed. Patients were evaluated with American Urological Association (AUA) symptom score, uroflowmetry, voiding cystourethrography (VCUG), and intraoperative urethroscopy. Stricture was limited to the glanular urethra (≤ 2 cm.) in all cases and 16 patients had lichen sclerosus. Strictured urethra was resected 0.5 cm proximal to the healthy urethra and a rectangular BMG with 4-cm length and 1.5- to 2.5-cm width (depending on the length of the defect) was rolled on a 24-Fr sound that calibrated the urethra. Proximal and distal edges of the cBMG were anastomosed circumferentially to the healthy mucosa and meatus, respectively. Foley catheter was removed within 10-14 days. Voiding symptoms, uroflowmetric parameters, and cosmesis were assessed at 1, 3, and 6 months, and yearly thereafter.
With a median follow-up of 38 months (range 12-96), 16 (84.2%) patients were cured. One patient developed early graft loss, and 2 patients developed stricture at proximal anastomotic site. Mean Q(max) (mL/s) increased from 7.8 ± 5.4 preoperatively to 21.8 ± 9.2 postoperatively (P = .001), and mean AUA score decreased from 26.7 ± 3.9 preoperatively to 7.3 ± 3.8 postoperatively (P < .001).
Our results suggest cBMG as a feasible alternative in 1-stage reconstruction of distal strictures confined to the glanular urethra because the glans penis has a good blood supply, providing an efficient circumferential graft take.

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    • "Traditionally, the use of BMG as a circumferential graft has been approached with caution in the literature because of its high overall failure rates compared with onlay or 2-stage techniques.[141516] However in recent times, reports have revealed an improved success rates with circular BMG for urethral substitution.[2324] The data presented by Barbagli et al. is encouraging and it suggests that circular BMG may be a feasible option in the management of bulbar urethral strictures because of good vascularity in this area.[23] "
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