scholarly journals Treatment of Bulbar Urethral Strictures. A Review, with Personal Critical Remarks

2003 ◽  
Vol 3 ◽  
pp. 443-454 ◽  
Author(s):  
Willem Oosterlinck
Keyword(s):  
Success Rate ◽  
Skin Flap ◽  
Scientific Data ◽  
New Wave ◽  
Success Rates ◽  
Free Graft ◽  
Two Stage ◽  
Urethral Strictures ◽  
Buccal Mucosa Graft ◽  
End To End

This is a review article on treatment of bulbar urethral strictures with personal critical remarks on newer developments. As a treatment of first intention there exists 4 options : dilatation, urethrotomy, end to end anastomosis and free graft, open urethroplasty. Success rate of dilatation and visual urethrotomy after 4 years is only 20 en 40 % respectively. Laser urethrotomy could not fulfill expectations. End to end anastomosis obtains a very high success rate but is only applicable for short strictures. Free graft urethroplasty obtains success rates of ± 80 %. There is considerable debate on the best material for grafting. Buccal mucosa graft is the new wave, but this is not based on scientific data. Whether this graft should be used dorsally or ventrally is also a point of discussion. In view of the good results published with both techniques it is probably of no importance. Intraluminal stents are not indicated for complicated cases and give only good results in those cases which can easily be treated with other techniques. Metal self-retaining urethral stent , resorbable stents and endoscopic urethroplasty is briefly discussed. Redo’s and complicated urethral strictures need often other solutions. Here skin flap from the penile skin and scrotal flap can be used. Advantages and drawbracks of both are discussed. There is still a place for two-stage procedures in complicated redo�s. The two-stage mesh-graft urethroplasty offers advantage over the use of scrotal skin. Some other rare techniques like substitution with bowel and pudendal thigh flap, to cover deep defects, are also discussed.

scholarly journals Buccal One-Stage Mucosal Graft Urethroplasty for Urethral Stricture. Results of 10 Years of Experience.

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Gezim Galiqi ◽  
Artan Koni ◽  
Flamur Tartari ◽  
Albert Pesha ◽  
Shpetim Ymeri ◽  
...  
Keyword(s):  
Success Rate ◽  
Urethral Stricture ◽  
Buccal Mucosa ◽  
Dorsal Surface ◽  
Success Rates ◽  
Lower Lip ◽  
Bulbar Urethra ◽  
Urethral Strictures ◽  
Buccal Mucosa Graft

Aim: Representing our data regarding use of buccal mucosa for treatment of recurrent urethral stricture. Evaluating effectiveness of buccal graft for reconstruction of urethral segment both penile and bulbar urethra. Materials and methods: We repaired 95 urethral strictures with buccal mucosa grafts from 2004 to 2015. Mean patient age was 39 years. The etiology of stricture was unknown in 54% of cases in other cases ischemia, trauma, instrumentation was the reason. 96% had undergone previous urethrotomy or dilation. The buccal mucosa graft was harvested from lower lip mostly. Mean graft length was 3.8 cm. The graft was placed on the ventral and dorsal bulbar urethral surface in 61 and 34 cases, respectively. In pendulous urethra we routinely use the dorsal graft the Asopa inlay graft or Barbagli onlay graft. Clinical outcome was considered a success or failure at the time that any postoperative procedure was needed, including dilation. Mean follow-up was 36 months (range 16 to 62). Results: We had a success rate of 77% with dorsal inlay or onlay flap for pendulous urethra inferior than ventral graft used for bulbar urethra which was 81% success rate. Conclusions: In our experience the placement of buccal mucosa grafts into the ventral or dorsal surface of the bulbar urethra showed an acceptable success rates 81% and 77% respectively. Longer times of follow up is need to see if the results deteriorated more.

scholarly journals Outcome of buccal mucosa urethroplasty in the management of urethral strictures

2017 ◽  
Vol 89 (2) ◽  
pp. 139 ◽  
Author(s):  
Basri Cakiroglu ◽  
Orhun Sinanoglu ◽  
Ersan Arda
Keyword(s):  
Success Rate ◽  
Buccal Mucosa ◽  
High Volume ◽  
Single Stage ◽  
Fistula Formation ◽  
Internal Urethrotomy ◽  
Voiding Difficulty ◽  
Urethral Strictures ◽  
Buccal Mucosa Graft

Objective: The objective of the study is to report the outcome of buccal mucosal urethroplasty. Materials and methods: The follow up data of 15 patients undergoing single stage urethroplasty from September 2010 to September 2015 were retropectively reviewed. They received buccal mucosa graft for urethroplasty. The patients were followed for complications and outcome. Results: Mean age was 53.7 ± 13.6 The stricture length ranged from 3 to 6 cm (mean 4.4 ± 0.8). The success rate for buccal mucosa urethroplasty (BMU) was 67.7% at 12th month. Three patients presenting with voiding difficulty in the 3rd month and one in the next 12 months, had urethral restenosis. One patient had fistula formation at 6th month postoperatively. Five patients underwent retreatment procedures such as internal urethrotomy, urethroplasty and/or internal urethrotomy. Conclusions: The buccal mucosa is easy to obtain and handle, therefore BMU can be safely and effectively managed outside high volume institutions.

scholarly journals Dorsolateral onlay urethroplasty for long segment anterior urethral stricture: outcome of a new technique

1970 ◽  
Vol 37 (3) ◽  
pp. 78-82 ◽  
Author(s):  
AKMK Habib ◽  
AKMK Alam ◽  
ATM Amanullah ◽  
H Rahman ◽  
AKMS Hossain ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Free Graft ◽  
Short Term ◽  
Chi Square ◽  
Urethral Strictures ◽  
Buccal Mucosa Graft ◽  
A New Technique ◽  
Student’S T ◽  
Level Of Significance

Conventional dorsal onlay urethroplasty requires circumferential mobilization of the urethra which might cause ischemia of the urethra. The present study was conducted to determine the feasibility and short term outcomes of applying dorsolateral free graft to treat anterior urethral stricture by unilateral urethral mobilization approach. This hospital based prospective interventional study was conducted in the Department of Urology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from July, 2009 to December, 2010. Total 30 patients with long-segment anterior urethral strictures were selected and treated by a dorsolateral free buccal mucosa graft. The test statistics used to analyse the data were Chi-square (Χ2) test and Student’s t-Test. For all analytical tests, the level of significance was set at 0.05 and p <0.05 was considered significant. After 6 months follow up results were prepared. Three (10%) patients developed wound infection. One (3.3%) patient developed urethrocutaneous fistula and one (3.3%) patient had chordee. Wound infections were treated conservatively. Twenty eight (93.3%) patients out of 30 had subjective improvement of urine flow after operation. All of these patients had postoperative Qmax >10 ml/sec. Postoperative Retrograde Urethrogram (RGU) of 28(93.3%) patients was free of stricture and 2(6.7%) patients showed stricture who had postoperative Qmax <10 ml/sec. Overall success rate was 93.3% at 3 to 12 months follow up. Unilateral urethral mobilization approach for dorsolateral free graft urethroplasty is feasible for long segment anterior urethral strictures with good short term success.DOI: http://dx.doi.org/10.3329/bmrcb.v37i3.9117 BMRCB 2011; 37(3): 78-82

scholarly journals Outcomes of transecting urethroplasty in management of different types of bulbar urethral strictures: single center experience

2021 ◽  
Author(s):  
Ayman Moussa Atwa ◽  
Ayman Ahmed Hassan ◽  
Samir Shabaan Orabi ◽  
Samir Abdelhakim Elgamal ◽  
Osama Mostafa Elgamal
Keyword(s):  
Erectile Dysfunction ◽  
Success Rate ◽  
De Novo ◽  
Primary Anastomosis ◽  
Success Rates ◽  
Single Center Experience ◽  
Urethral Strictures ◽  
Micturating Cystourethrogram ◽  
A Prospective Study ◽  
Anastomotic Urethroplasty

Background: The study aimed to evaluate the outcomes of transecting bulbar urethroplasty techniques used for management of bulbar urethral stricture as regards the success rate and sexual dysfunction.Methods: Our study was a prospective study and it was carried out at urology department Tanta university, Egypt. The study was approved our ethical committee and an informed consent was obtained from all participants. Thirty patients underwent transecting urethroplasty either excision and primary anastomosis (EPA) or augmented anastomotic urethroplasty. Assessment of the sexual function by sexual health inventory for men (SHIM) questionnaire and postoperatively. Retrograde urethrogram (RGU) and micturating cystourethrogram (MCUG) were performed by an experienced urological surgeon.Results: The age of studied patients ranged from 15-72 years with a mean of  41±13.87. The length of stricture ranged from 2-3 cm with a mean of 2.57±0.38. The stricture was non obliterative in 13 patients (43.3%), obliterative in 4 patients (13.3%) and near obliterative in 13 patients (43.3%). Anastomotic urethroplasty was carried out in 20 out of 30 patients (66.7%) and augmented anastomotic urethroplasty was carried out in 10 out of 30 patients (33.3%). The success rate was 90%. As regard erectile dysfunction, 5 patients reported erectile dysfunction (16.7%).Conclusions: Anastomotic urethroplasty of short segment bulbar strictures continues to have excellent success rates and durability, but some patients who undergo anastomotic urethroplasty experience de novo sexual dysfunction.

scholarly journals Is anastomotic urethroplasty is really superior than BMG augmented dorsal onlay urethroplasty in terms of outcomes and patient satisfaction: Our 4-year experience

2015 ◽  
Vol 9 (1-2) ◽  
pp. 22 ◽  
Author(s):  
Anil Kumar Choudhary ◽  
Nawal K. Jha
Keyword(s):  
Patient Satisfaction ◽  
Skin Flap ◽  
Short Segment ◽  
Buccal Mucosa Graft ◽  
Micturating Cystourethrogram ◽  
Retrograde Urethrogram ◽  
Dorsal Onlay ◽  
End To End ◽  
Anastomotic Urethroplasty

Introduction: We analyzed the outcomes of augmented buccal mucosa graft (BMG) dorsal onlay urethroplasty and anastomotic urethroplasty in the management of urethral stricture.Methods: Patients having a stricture length more than 2 cm were treated by augmented BMG dorsal onlay urethroplasty; patients with a stricture length less than 2 cm were managed by excision and end-to-end anastomotic urethroplasty. The postoperative retrograde urethrogram, micturating cystourethrogram, and uroflowmetry were compared to preoperative values. The postoperative subjective symptoms and complications were recorded and analyzed.Results: In total, 90 patients were included in this study. Forty-five patients had an average stricture length of 5.9 cm; they underwent BMG augmented dorsal onlay urethroplasty. Of these, 7 (15.55%) patients came with recurrence, while 38 (84.44%) were asymptomatic, in the average follow-up period of 32.8 months. The next 45 patients underwent excision of the stricture and end-to-end anastomosis. Of these, 6 (13.33%) failed on therapy and the remaining 39 (86.66%) were asymptomatic during the average follow-up period of 28.4 months.Conclusion: The technique of BMG dorsal onlay is easy to do, it is very reliable, has high success rate, less postoperative complications and better patient satisfaction compared to anastomotic urethroplasty. Our study has its limitations. Recurrent cases of urethroplasty and hypospadias were excluded from this study. Recurrent stricture cases were eliminated to overcome bias. Cases of hypospadias are still best treated by axial or random penile skin flap as BMG augmentation cannot create a long urethral tube. Based on our 4-year experience, we recommend BMG augmented urethroplasty long and short segment stricture of the urethra.

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