Buccal mucosa graft tube urethroplasty for the treatment of bulbopenile urethral trauma accompanied with massive tissue loss due to improvised explosive device injury

Urinary diversion with suprapubic cystostomy and delayed urethroplasty is recommended for the treatment of penetrating posterior urethral traumas. A devastating urethral trauma caused by a blast injury due to an improvised explosive device is an extremely rare clinical condition and treatment options are limited due to accompanying massive tissue and muscle loss. Staged urethral reconstruction using a pedicled gracilis muscle flap with a skin or buccal mucosa graft is the preferred treatment option for complex urethral traumas. In case of a devastated urethra due to an intensive explosive device injury, treatment options are limited, especially if the gracilis muscle cannot be used. We report the case of a 30-year-old male patient with a devastated bulbopenile urethra and massive local tissue and adjacent muscle loss including the gracilis muscle. The patient was successfully treated by buccal mucosa graft tube urethroplasty. Urethral stricture recurred but was successfully treated by means of endoscopy. At 24 months’ follow-up, the patient was continent and urinated normally.