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

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.

Download Full-text

Outcome of buccal mucosa urethroplasty in the management of urethral strictures

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2017.2.139 ◽

2017 ◽

Vol 89 (2) ◽

pp. 139 ◽

Cited By ~ 1

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.

Download Full-text

COMPARATIVE ANALYSIS OF VENTRALAND DORSAL BUCCAL MUCOSA GRAFT AUGMENTATION URETHROPLASTY IN STRICTURE BULBAR URETHRA.

10.36106/ijsr/2714230 ◽

2020 ◽

pp. 56-57

Author(s):

Yagyadev Arya ◽

Rahul Goel

Keyword(s):

Buccal Mucosa ◽

Anastomotic Site ◽

Success Rates ◽

Urethral Strictures ◽

Buccal Mucosa Graft ◽

Retrograde Urethrogram ◽

One Year ◽

Rate Of Failure

Objective: To compare long term outcomes of buccal mucosa graft(BMG) augmentation urethroplasty for long-segment bulbar urethral strictures done by placing the graft ventrally and dorsally. Material and Methods: We conducted a single institution retrospective study on 32 patients who underwent BMG augmentation urethroplasty for non traumatic bulbar urethral stricture between January 2010- December 2018. The cases were divided into two groups based on the site of placement of the BMG graft i.e (a) Ventral (n=22) , (b)Dorsal(n=10). Follow-up period was from one year to five years. Patients with failed outcomes underwent Urethroscopy or Retrograde Urethrogram to note the site of recurrence of stricture. Results: Out of 32 cases 26 (81%) were successful and 6 (19%) failed.The success rates for ventral and dorsal BMG augmentation procedures were 81% and 70%,respectively(p=0.45).Among 6 failed cases 3 (9%)cases had stricture at proximal anastomotic site,2 (2%)cases at distal anastomotic site& 1 (1%)case at pan graft site(p=0.08). Conclusion: The overall success rate for BMG augmentation urethroplasty is equal for all techniques.Dorsal onlay urethroplasty provides better exposure of proximal anastomotic site thus it is associated with minimum proximal anastomotic site recurrence rates.Patient with extensive spongiofibrosis and long segment strictures had higher rate of failure.

Download Full-text

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

International Surgery Journal ◽

10.18203/2349-2902.isj20200535 ◽

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.

Download Full-text

MP13-12 MIDTERM FOLLOW UP OF INTERNAL URETHROTOMY IN PATIENTS WITH RECURRENT URETHRAL STRICTURE AFTER BUCCAL MUCOSA GRAFT URETHROPLASTY

The Journal of Urology ◽

10.1016/j.juro.2014.02.681 ◽

2014 ◽

Vol 191 (4S) ◽

Cited By ~ 3

Author(s):

Clemens Rosenbaum ◽

Marianne Schmid ◽

Tim Alexander Ludwig ◽

Philip Reiss ◽

Roland Dahlem ◽

...

Keyword(s):

Urethral Stricture ◽

Buccal Mucosa ◽

Internal Urethrotomy ◽

Buccal Mucosa Graft ◽

Buccal Mucosa Graft Urethroplasty

Download Full-text

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

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v37i3.9117 ◽

1970 ◽

Vol 37 (3) ◽

pp. 78-82 ◽

Cited By ~ 1

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

Download Full-text

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

The Scientific World JOURNAL ◽

10.1100/tsw.2003.34 ◽

2003 ◽

Vol 3 ◽

pp. 443-454 ◽

Cited By ~ 6

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.

Download Full-text

Outcomes of Dorsal and Ventral Buccal Graft Urethroplasty at a Tertiary Hospital in Uganda

ISRN Urology ◽

10.1155/2014/316819 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

S. Kaggwa ◽

M. Galukande ◽

H. Dabanja ◽

H. Luweesi

Keyword(s):

Success Rate ◽

Buccal Mucosa ◽

Tertiary Hospital ◽

Sub Saharan Africa ◽

Team Approach ◽

Sexually Transmitted ◽

Urethral Strictures ◽

Sub Saharan ◽

A Prospective Study

Purpose. Although the use of buccal mucosa in substitution urethroplasty has been practiced for some years, it has not been free of controversy over which surgical technique is the most appropriate to use. There is paucity of data in Sub-Saharan Africa about its success; this study presents the outcomes of dorsal and ventral buccal graft urethroplasty at a sub-Saharan tertiary hospital. Methods. This is a prospective study in which buccal mucosa was used for ventral and dorsal grafts; followup was up to two years. All patients provided informed written consent for the procedures. Results. Seventy-two patients with bulbar urethral strictures underwent buccal graft one-stage urethroplasty. Mean age was 55 years; etiology of the strictures was postinflammatory due to urethritis from sexually transmitted infections 97% (70/72) and trauma 3% (2/72). Buccal mucosa grafts were harvested from the cheek using a two-team approach. Grafts were placed on the ventral and dorsal urethral surfaces in 32 and 40 cases, respectively; the success rate was 84 and 80%, respectively. Repeated urethroplasty was successfully done among 10% (7/72) and patients reported resolution of symptoms in the follow-up period. Conclusion. There was no difference between dorsal and ventral onlay buccal graft outcomes for bulbar urethral strictures. The success rate was 80 to 84%.

Download Full-text

Results of Buccal Mucosal Graft Urethroplasty in Management of Anterior Urethral Stricture – Experience in a Single Center

Bangladesh Journal of Urology ◽

10.3329/bju.v22i2.50098 ◽

2020 ◽

Vol 22 (2) ◽

pp. 128-131

Author(s):

Mohammad Abdul Aziz ◽

Shafiqur Rahman ◽

Mirza Mahbubul Hasan

Keyword(s):

Success Rate ◽

General Hospital ◽

Urethral Stricture ◽

Buccal Mucosa ◽

Single Center ◽

Internal Urethrotomy ◽

Exclusion Criteria ◽

Urethral Strictures ◽

Buccal Mucosal Graft ◽

Optical Internal Urethrotomy

Objective: To share our experience with buccal mucosal graft (BMG) urethroplasty for the management of anterior urethral strictures in BIRDEM General Hospital, Dhaka. Materials and methods: This study was conducted from January 2013 to January 2018. Patients selected according to inclusion and exclusion criteria. The oral mucosal characteristics were assessed in all patients during the initial workup. Single stage dorsolateral onlay graft urethroplasty done in all patients. They were followed according schedule for outcome and complications. Result:Total 59 patients were studied. Overall success rate of BMG urethroplasty was 88.1% at 12th month. Complications include development of periurethral abscess (3.4%), restructure (8.5%) development of fistula (1.7%). Total 8 patients underwent retreatment procedures like drainage of periurethral abscess, dilatation, optical internal urethrotomy (OIU) and revision urethroplasty. Conclusion:The buccal mucosa is easy to obtain and handle, therefore BMG urethroplasty is a safe and effective in managing anterior urethral stricture. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.128-131

Download Full-text

Outcome of Dorsolateral OnlAy OMG Urethroplasty for Anterior Urethral Stricture

Bangladesh Journal of Urology ◽

10.3329/bju.v16i2.45938 ◽

2020 ◽

Vol 16 (2) ◽

pp. 37-42

Author(s):

Tohid Md Saiful Hossain ◽

Md Asaduzzaman ◽

Md Afzalur Rahman ◽

Md Nasir uddin ◽

Md Habibur Rahman ◽

...

Keyword(s):

Oral Mucosa ◽

Urethral Stricture ◽

Donor Site ◽

Maximum Flow ◽

Successful Outcome ◽

Term Outcome ◽

Lower Lip ◽

Urethral Strictures ◽

Buccal Mucosal Graft

Objective: To determine the feasibility, safety, efficacy and short term outcome of using new surgical technique for repair of anterior urethral stricture Introduction: The conventional approach for management of long segment anterior urethral stricture is a two stage Johansons repair along with the use of free grafts if required. Now a days the preferred management of urethral stricture involving long segments of anterior urethra is dorsal only oral mucosa Augmentation urethroplasty which requires circumferential mobilization of urthera that might cause ischaemia of urethra in addition of chordee. For that we adopted new technique (kulkarnis) of dorsolateral onlay buccal mucosal graft one sided anterior urethroplasty in which only unilateral urethral mobilization done through perineal approach. Materials and Methods: A total of 50 patients underwent urethroplasty for anterior urethral strictures using dorsolateral onlay BMG from April 2010 to December 2012 at NIKDU, JBFH, BSMMU and BDM Hospital. We selected 16 to 70 years old male (mean age 39 years) underwent a one-sided dorsolateral oral mucosal graft urethroplasty. The mean (range) stricture length was 6.5 (4.5-9) cm in patients with single bulbar urethral involvement and 10.5 (8.5–15.0) cm in patients with panurethral strictures. Free graft was taken from oral mucosa either lower lip or cheeks. Follow up was done by uroflowmetry at 3rd week, after removal of penile catheter and repeat at 3rd and at 6th month. In addition to uroflometry – RGU & MCU was done at 3rd month and Urethrocystoscopy was done at 6th month follow up. The results were classified into the following outcomes. Success was defined as a maximum flow rate of >10 ml/sec, normal RGU, and/or urethroscopy (with a 19 Fr. sheath). Failure was defined as the presence of obstructive urinary tract symptoms, Qmax <10 ml/sec, stricture diagnosed on retrograde urethrogram/ urethroscopy, and the need for any postoperative urethral intervention. Result: The overall follow up was 12-30 months. Of the 50 patients 45 (90%) had a successful outcome and 5(12%) had failure. 3 failure treated by OIU and 2 by meatal dilatation. No significant donor site defect was observed. Bangladesh Journal of Urology, Vol. 16, No. 2, July 2013 p.37-42

Download Full-text

Buccal mucosa graft urethroplasty in a case of urethral amyloidosis presenting with long anterior urethral stricture

Canadian Urological Association Journal ◽

10.5489/cuaj.2957 ◽

2015 ◽

Vol 9 (11-12) ◽

pp. 830 ◽

Cited By ~ 2

Author(s):

Dmitry Kurbatov ◽

Sergey Dubskiy ◽

Alex Lepetukhin ◽

Borko Stojanovic ◽

Miroslav L. Djordjevic

Keyword(s):

Urothelial Carcinoma ◽

Urethral Stricture ◽

Buccal Mucosa ◽

Rare Condition ◽

Successful Outcome ◽

Buccal Mucosa Graft ◽

Buccal Mucosa Graft Urethroplasty

Urethral amyloidosis is a rare condition, but clinically relevant because it can mimic urothelial carcinoma. We report a case of localized urethral amyloidosis presenting with a long anterior urethral stricture. We used extensive grafts of buccal mucosa for standard augmentation urethroplasty, with a successful outcome at the 2-year follow-up.

Download Full-text