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


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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    ABSTRACT: The correction of fossa navicularis strictures poses a distinct reconstructive challenge as it requires attention to cosmesis, in addition to urethral patency. Different graft and flap based repairs have been described with variable success rates. However, the ideal management remains unclear. The feasibility and efficacy of a single stage ventral onlay buccal mucosa graft urethroplasty (VOBMGU) for navicular fossa strictures (NFS) was evaluated in the present study. All patients with NFS attending urology out-patient department from March, 2009 onward accepting VOBMGU were evaluated prospectively. Patients with minimum 1 year of follow-up were included for analysis. The technique involves opening the diseased stenosed meatus ventrally up to the corona. The diseased mucosa is excised leaving a midline strip of native urethral mucosa on the dorsal side. The buccal mucosal graft (BMG) is fixed on either side of this strip over a 24 Fr. silicone catheter. The glans wings are apposed in midline taking anchoring bites on the mucosal graft ventrally. Post-operatively patients were reviewed at 1, 3, 6 and 12 months and annually thereafter. Cosmetic acceptance and splaying of the urinary stream was assessed with individual questionnaires. A total of six patients underwent VOBMGU. Average flow rate at 3 months post-operatively was 12 ml/s. The end result was cosmetically highly acceptable. There was no fistula in any of the cases. With a median follow-up of 37 months, only one patient had a recurrence of stricture in a proximal site. VOBMGU is a viable technique for reconstruction of NFS with promising short term results. However, long-term follow-up is necessary.
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    ABSTRACT: For ventral buccal mucosa graft onlay during bulbar urethroplasty, spongioplasty with advancement and closure of the corpus spongiosum is ordinarily performed to stabilize the graft. In the pendulous and distal bulbar urethra, the spongiosum is often too thin to allow complete graft coverage. We describe the results of a novel technique for ventral graft coverage using periurethral vascularized tissue, and we compared these results to those of conventional spongioplasty. Retrospective review of all urethroplasties performed by two surgeons at separate tertiary care facilities from July 2007 to July 2012 was performed. Single stage urethroplasties involving ventral buccal mucosa graft placement were selected for analysis. Conventional spongioplasty was performed whenever possible (Group 1). When spongiosal tissue was inadequate for graft coverage, flaps of periurethral tissue were mobilized bilaterally and sutured together in the midline as a "pseudospongioplasty" (Group 2) to provide coverage. Outcomes of the two techniques were compared. Among 637 urethroplasties performed during the 5-year study period, 102 having buccal mucosa graft onlay met inclusion criteria (16%). Pseudospongioplasty was performed in 46/102 (45%), predominantly in the pendulous urethra (34/46, 74%), with a success rate of 80% (37/46) at a mean followup of 41 months. Conventional spongioplasty had a similar success rate of 84% (47/56) at a mean followup of 39 months, (p=0.645). For the conventional spongioplasty the mean stricture length was 4.7 cm, compared to 5.8 cm for the pseudospongioplasty (p=0.028). Ventral buccal mucosa grafts can be applied reliably to various locations throughout the anterior urethra. For distal grafts, flaps of periurethral tissue provide a suitable host bed for revascularization, with results that are equivalent to conventional spongioplasty.
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    ABSTRACT: Therapy for anterior combined with posterior urethral stricture is difficult and controversial. This study aims to introduce a standard process for managing anterior combined with posterior urethral stricture. 19 patients with anterior combined with posterior urethral stricture were treated following our standard process. Average (range) age was 52 (21-72) years old. In this standard process, anterior urethral stricture should be treated first. Endoscopic surgery is applied for anterior urethra stricture as a priority as long as obliteration does not occur, and operation for posterior urethral stricture can be conducted in the same stage. Otherwise, an open reconstructive urethroplasty for anterior urethral is needed; while in this condition, the unobliterated posterior urethra can also be treated with endoscopic surgery in the same stage; however, if posterior urethra obliteration exists, then open reconstructive urethroplasty for posterior urethral stricture should be applied 2-3 months later. The median (range) follow-up time was 25.8 (3-56) months. All 19 patients were normal in urethrography after 1 month of the surgery. 4 patients (21.1%) recurred urethral stricture during follow-up, and the locations of recurred stricture were bulbomembranous urethra (2 cases), bulbar urethra (1 case) and bladder neck (1 case). 3 of them restored to health through urethral dilation, yet 1 underwent a second operation. 2 patients (10.5%) complaint of dripping urination. No one had painful erection, stress urinary incontinence or other complications. The management for anterior combined with posterior urethral stricture following our standard process is effective and safe.
    No preview · Article · Jun 2015 · International Journal of Clinical and Experimental Medicine