scholarly journals An audit of management of male urethral stricture and it’s outcome: a single centre retrospective review

2020 ◽  
Vol 7 (3) ◽  
pp. 774
Author(s):  
Puskal Kumar Bagchi ◽  
Sarbartha K. Pratihar ◽  
Rajeev T. P. ◽  
Sasanka K. Barua ◽  
Debanga Sarma ◽  
...  
Keyword(s):  
Success Rate ◽  
Urethral Stricture ◽  
Poor Quality ◽  
Single Stage ◽  
Single Centre ◽  
Short Segment ◽  
Onlay Technique ◽  
Dorsal Onlay ◽  
End To End ◽  
Staged Reconstruction

Background: Anterior urethral stricture involves penile, bulbar or panurethra with varied aetiology. Direct vision internal urethrotomy (DVIU), stricture excision with primary end to end anastomosis, single stage or staged reconstruction with local flap or buccal mucosal graft (BMG) are surgical options.Methods: This single centre retrospective study was conducted from April 2017 to March 2019. Patient underwent DVIU, stricture excision with primary end to end anastomotic, staged urethroplasty, BMG urethroplasty (BMGU) dorsal inlay Asopa technique, dorsal onlay Kulkarni technique and ventral onlay technique depending on site and extent of strictures. Preoperative, intraoperative, post-operative data were reviewed.Results: Here, 51 patients underwent DVIU for single soft short segment bulbar urethral stricture with success rate 58.82%. 26 patients with post traumatic short segment bulbar urethral stricture underwent excision and primary end to end anastomosis with success rate 92.31%. Patients with long segment bulbar urethral stricture underwent either dorsal onlay (n=19) or ventral onlay (n=14) BMGU with success rate 89.47% and 85.71% respectively. Total 59 patients with long segment penile or pan urethral stricture underwent either single stage (n=27) or staged reconstruction (n=32) with success rate of 85.18% and 90.63% respectively. Patients with staged reconstruction had significantly longer hospital stay (p<0.0001) and poor quality of life due to laid opened urethra. Asopa’s dorsal inlay (n=15) and Kulkarni’s dorsal onlay (n=12) BMGU had equivalent success rate of 86.67% and 83.33% and comparable complications.Conclusions: Surgery for urethral stricture differs according to site and extent of stricture. Single stage BMG urethroplasty is preferred modality for long segment bulbar, penile and panurethral stricture. 

scholarly journals Dorsal onlay buccal mucosa graft urethroplasty for bulbar urethral stricture: a single centre experience

2020 ◽  
Vol 36 ◽  
Author(s):  
Idorenyin Cletus Akpayak ◽  
Samaila Ibrahim Shuaibu ◽  
Chima Gideon Ofoha ◽  
Ayodele Olufikayo Oshagbemi ◽  
Nuhu Kutan Dakum ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Buccal Mucosa ◽  
Single Centre ◽  
Buccal Mucosa Graft ◽  
Single Centre Experience ◽  
Dorsal Onlay ◽  
Buccal Mucosa Graft Urethroplasty

scholarly journals Management of men with ultra-short penile urethral stricture using augmented anastomotic penile skin flap urethroplasty; a retrospective analysis

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Abdel W. El-Kassaby ◽  
Mohammed Saber Khalaf ◽  
Ahmed M. Reyad
Keyword(s):  
Success Rate ◽  
Urethral Stricture ◽  
Flow Rate ◽  
Skin Flap ◽  
Maximum Flow ◽  
Maximum Flow Rate ◽  
Control Group ◽  
Study Group ◽  
Significant Difference ◽  
Dorsal Onlay

Abstract Background The management of short anterior urethral stricture is challenging. Our study aims to evaluate the outcome of augmented anastomotic urethroplasty (AAU) for the management of men with ultra-short penile urethral stricture, and to compare it with the dorsal onlay buccal mucosa graft. Methods Databases of two tertiary referral centres were retrospectively reviewed to retrieve data of men with ultra-short penile urethral stricture who underwent urethroplasty from 2013 to 2020. Patients who underwent AAU with ventral onlay pedicled skin flap were considered the study group, while patients treated with the dorsal onlay graft augmentation were included as controls. Surgical outcomes included urethral patency, improvement in the maximum flow rate (Qmax), change in sexual satisfaction, and any reported complications. Results Thirty-four patients (and 30 controls) with a median age of 26–27 years were included in the study. The maximum flow rate improved significantly in both groups compared to the preoperative value (p < 0.001). The success rate was 88% in the study group compared to 76.7% in the control group. There was no statistically significant difference in the frequency of postoperative penile curvature nor the ventral sacculation between the two groups (p = 0.788 and 0.913). The operative time was statistically significantly longer in the control group (p = 0.044), while the frequency of postoperative void dripping was much higher in the study group (p = 0.007). Conclusion The success rate and complications of AAU for men with ultra-short penile urethral stricture were comparable to the dorsal buccal graft.

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.

History and Evolution of Dorsal Onlay Urethroplasty for Bulbar Urethral Stricture Repair using Skin or Buccal Mucosal Grafts

2007 ◽  
Vol 74 (4) ◽  
pp. 233-241 ◽  
Author(s):  
G. Barbagli ◽  
M. Lazzeri
Keyword(s):  
Urethral Stricture ◽  
Buccal Mucosa ◽  
Graft Material ◽  
Skin Grafts ◽  
Penile Skin ◽  
Onlay Graft ◽  
Onlay Technique ◽  
Dorsal Onlay ◽  
Over Time ◽  
Anastomotic Urethroplasty

Objectives To illustrate the history and the evolution over time of bulbar dorsal onlay urethroplasty, comparing outcomes when using buccal mucosa or skin grafts. Materials and Methods Ninety-four patients underwent bulbar urethral reconstruction using two dorsal onlay techniques, namely augmented anastomotic urethroplasty and dorsal onlay graft urethroplasty. Preoperative evaluation included clinical history, physical examination, urine culture, residual urine measurement, uroflowmetry and urethrography. Thirty-four patients underwent augmented anastomotic urethroplasty using penile skin (10 cases) or buccal mucosa (24 cases) grafts. Sixty patients underwent dorsal onlay graft urethroplasty using penile skin (38 cases) or buccal mucosa (22 cases) grafts. Forty-eight out of 94 patients received skin grafts and 46 buccal mucosal grafts. Results Sixty-four (68%) out of 94 cases were successful, whereas 30 (32%) failed. The 34 augmented anastomotic urethroplasties provided successful outcomes in 24 cases (70.6%), but poor outcomes in 10 (29.4%) cases. The 60 dorsal onlay graft urethroplasty proved to be successful in 42 cases (70%), failing in 18 (30%) cases. Twenty-eight (58.3%) out of 48 penile skin grafts were successful and 20 (41.7%) failed. Thirty-six (78.3%) out of 46 buccal mucosa grafts were successful and 10 (21.7%) failed. The 30 failed cases were then treated with internal urethrotomy in 14 cases (46.7%), perineal urethrostomy in 8 cases (26.7%), two-stage repair in 4 cases (13.3%), and one-stage repair in 4 cases (13.3%). Conclusions The dorsal onlay technique used for bulbar urethral stricture repair has changed over time. In our experience, the buccal mucosa seems to be the best substitute graft material for bulbar urethroplasty using dorsal approach.

scholarly journals Dorsal onlay versus dorsal inlay buccal mucosal graft urethroplasty for anterior urethral stricture: a single centre retrospective study

2020 ◽  
Vol 7 (3) ◽  
pp. 826
Author(s):  
Puskal Kumar Bagchi ◽  
Ashish Ghanghoria ◽  
Rajeev T. P. ◽  
Sasanka Kumar Barua ◽  
Debanga Sarma ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Maximum Flow ◽  
P Value ◽  
Common Disease ◽  
Success Rates ◽  
Buccal Mucosal Graft ◽  
Onlay Technique ◽  
Group A ◽  
Dorsal Onlay ◽  
Group B

Background: Urethral stricture is a relatively common disease. The choice of surgery is based on the stricture location, length of the stricture and etiology. Buccal mucosal graft (BMG) urethroplasty with Asopa and Kulkarni techniques, revolutionized the approach to anterior urethral stricture repair. Objective of the study was to compare both the dorsal onlay BMG urethroplasty technique of Kulkarni and the dorsal inlay BMG urethroplasty technique of Asopa for the management of long anterior urethral stricture.
Methods: From January 2015 to October 2019, a total of 90 patients with long anterior urethral strictures were randomized into two groups. Group A (42 patients) managed by Kulkarni technique. Group B (48 patients) managed by Asopa technique. BMG urethroplasty was considered successful if no further procedure required postoperatively with maximum flow rate >15 ml/s during the follow-up period.Results: The success rate in group A and B were 80.9% and 87.5%, respectively. The mean operative time was significantly longer in group A (175±22.6 min) than in group B (102±18.14 min, p-value <0.001). The average blood loss was significantly higher in group A (154±15.65 ml) than in group B (112.76±12.62 ml, p-value <0.012).Conclusions: The dorsal onlay technique of Kulkarni and the dorsal inlay technique of Asopa buccal mucosal graft urethroplasty are reliable and satisfactory procedures with good success rates and minimum complications.

scholarly journals Outcome of Anastomotic Urethroplasty for Bulbar Urethral Stricture Our Experience

2020 ◽  
Vol 23 (1) ◽  
pp. 56-61
Author(s):  
Md Shahidul Islam ◽  
Md Mostafiger Rahman ◽  
Md Fazal Naser ◽  
Wahida Akhtar Chowdhury ◽  
Md Abdul Baten
Keyword(s):  
Clinical Outcome ◽  
Treatment Failure ◽  
Urethral Stricture ◽  
Surgical Outcome ◽  
Operation Time ◽  
Short Segment ◽  
End To End ◽  
Multiple Treatments ◽  
Anastomotic Urethroplasty

Objective: For evaluation of patients who underwent bulbar end-to-end anastomosis to assess surgical outcome. Materials and Methods: We reviewed 53 patients with an average age of 44 years who underwent bulbar end-to-end anastomosis from January 2013 to July 2018. A total of 9 patients (16.98%) underwent urethrotomy, dilation, or multiple treatments before referral to our center. Stricture length d”2cm, free from infection and completed at least 6 months of follow up were included. Patients were evaluated post operatively by uroflowmetry at 3, 6, 12 months of follow up and yearly thereafter. Clinical outcome was considered a treatment failure when any postoperative instrumentation was needed. Results: Mean age 44 (SD±7.6, range 33 to 54 years). Stricture etiology was blunt perineal trauma 32 (60.37%), infection 12(22.64%), idiopathic 06(11.32%) and iatrogenic 03(05.67%). Mean operation time was 95 minutes (range, 50 to 140 minutes) and mean excised stricture length was 1.4 cm (range, 0.5 to 2 cm). 44 patients (83.02%) were symptom-free and required no further procedure. Strictures recurred in 9 patients (16.98%) within 2 to 5 months after surgery. Of 9 recurrences, 3 patient was managed successfully by urethrotomy, whereas the remaining 6 did not respond to urethrotomy or dilation and required additional urethroplasty. Conclusions: Excision and end-to-end anastomosis urethroplasty is an excellent procedure for short segment bulbar urethral stricture. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.56-61

scholarly journals Dorsal onlay buccal mucosal graft or penile skin graft substitution urethroplasty in bulbar urethral stricture: compare the outcome and review

2020 ◽  
Vol 7 (3) ◽  
pp. 664
Author(s):  
Atul K. Khandelwal
Keyword(s):  
Success Rate ◽  
Urethral Stricture ◽  
Skin Graft ◽  
Buccal Mucosa ◽  
Penile Skin ◽  
Buccal Mucosa Graft ◽  
Buccal Mucosal Graft ◽  
Study Results ◽  
Dorsal Onlay

Background: Authors describe their experience with dorsal onlay urethroplasty using Buccal mucosal graft or penile skin graft through dorsal sagittal urethrotomy for bulbar urethral stricture.Methods: From 2014 to 2017, 29 male patients with bulbar urethral stricture have been treated by one stage dorsal onlay substitution urethroplasty using buccal mucosal graft and penile skin graft. Patients with balanitis xerotica obliterans, unhealthy penile skin, oral mucosa pathology or those who had undergone more than one urethral dilation/internal urethrotomy or urethroplasty were excluded from study. Results were analyzed at 6th and 12th month follow up with clinical history and uroflowmetry. Clinical outcome was considered a failure when any postoperative instrumentation was needed, including dilation or optical internal urethrotomy.Results: A total of 16 men age between 21 to 56 years for buccal mucosa graft (BMG) urethroplasty and 13 men age between 18 to 59 years underwent dorsal onlay substitution urethroplasty using BMG and penile skin graft (PSG). Mean stricture length was 4.2 cm (3.8-6) for BMG urethroplasty and 4.1 cm (3.2-5) for PSG urethroplasty. Mean length and width of graft were 4.2 cm and 2.6 cm respectively in BMG urethroplasty while 4.6 cm and 2.5 cm in PSAG urethroplasty. Average follow up months were 13.4 months with overall success rate 87.5% in BMG urethroplasty while average follow up months were 14.6 months with overall success rate 82.3% in PSG urethroplasty.Conclusions: On short term follow up substitution urethroplasty using both penile skin and buccal mucosa graft have comparable results.  

Lichen sclerosis–induced long segment anterior urethral stricture: The early outcome of one-stage repair using dorsolateral onlay buccal mucosa graft

2021 ◽  
pp. 039156032110033
Author(s):  
Atef Fathi ◽  
Omar Mohamed ◽  
Osama Mahmoud ◽  
Gamal A Alsagheer ◽  
Ahmed M Reyad ◽  
...  
Keyword(s):  
Success Rate ◽  
Urethral Stricture ◽  
Flow Rate ◽  
Urine Volume ◽  
Maximum Flow ◽  
Maximum Flow Rate ◽  
P Value ◽  
Onlay Graft ◽  
Voiding Symptoms ◽  
Stricture Recurrence

Background: Substitution urethroplasty using buccal mucosal grafts can be performed by several approaches including ventral onlay graft, dorsal onlay graft, or ventral urethrotomy with dorsal inlay graft. Our study aims to evaluate the surgical outcome of dorsolateral buccal mucosal graft for long segment anterior urethral stricture >6 cm in patients with Lichen sclerosus (LS). Methods: A retrospective study included patients who underwent repair for long segment anterior urethral stricture >6 cm due to LS between January 2013 and April 2019. All patients were followed-up at 3, 6, 9, and 12 months postoperatively and then yearly by clinical symptoms, uroflowmetry, and calculation of post-void residual urine volume. Retrograde urethrogram was requested for patients with voiding symptoms or decreased maximum flow rate. Stricture recurrence that required subsequent urethrotomy or urethroplasty was considered failure. The success rate and surgical complications were collected and analyzed. Results: Thirty patients were identified. The median age (range) was 39 (25–61) years and a median (range) stricture length was 8 (6–14) cm. Most of postoperative complications were of minor degree. The success rate at median follow-up of 15 (12–24) months was 86.5%. The median maximum flow rate increased significantly from 6 (2–11) ml/s preoperatively to 18 (range: 6–23) ml/s at the 6th month ( p value < 0.001). Conclusion: Dorsolateral buccal mucosal grafts urethroplasty for long anterior urethral stricture caused by LS has a high success rate and low risk of complications including stricture recurrence.

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