Outcome of Dorsolateral OnlAy OMG Urethroplasty for Anterior Urethral Stricture

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

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Substitution Buccal Mucosal Graft Urethroplasty for Long Segment Anterior Urethral Stricture : Our Experience in Dorsolateral Onlay Approach

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v20i2.56466 ◽

2021 ◽

Vol 20 (2) ◽

pp. 14-17

Author(s):

Shiba Prasad Nandy ◽

- Md Asaduzzaman ◽

Kamal Uddin Mazumder ◽

Sakhawat Mahamud Khan ◽

Md Monowar Ul Hoque

Keyword(s):

Urethral Stricture ◽

Maximum Flow ◽

Anastomotic Site ◽

Short Term ◽

College Hospital ◽

Term Outcome ◽

Buccal Mucosal Graft ◽

Short Term Outcome ◽

Onlay Technique

Background: Currently the most favorable single stage procedure for management of long segment anterior urethral stricture is dorsal onlay technique of urethroplasty. This required circumferential extensive mobilization of the urethra, which might cause ischemia of urethra in addition to chordee. To evaluate the short term outcome of dorsolateral onlay BMG (Buccal Mucosal Graft) urethroplasty by unilateral urethral mobilization for treatment of long segment anterior urethral stricture Materials and methods: A prospective experimental study from January 2016 to December 2018 is carried out in Department of Urology, Chittagong Medical College Hospital (CMCH) Chattogram, Bangladesh. Total 32 patients of long segment anterior urethral stricture were treated by dorsolateral onlay BMG urethroplasty by unilateral urethral mobilization. Stricture >2cm were included; RGU, MCU and Uroflowmetry were the mainstay of assessment. Success was defined as maximum flow rate >15 ml/s, normal RGU and/ urethroscopy. Failure considered as presence of obstructive symptoms, Qmax < 15 ml/s, stricture on RGU and any post-operative urethral intervention. Results: Mean stricture length was 48.72mm (Range: 30-77mm) and mean follow up time was 22.4months (Range: 12-40 months). Three patients were found to develop stricture at proximal anastomotic site during follow up and required optical internal urethrotomy and considered as failure. 01 patients developed Surgical Site Infection (SSI) which resolved after regular dressing. Success rate was 90.7% Conclusion: Dorsolateral onlay BMG urethroplasty by unilateral mobilization is feasible, safe and easily adoptable for long segment anterior urethral stricture with good short term outcome. Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 14-17

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Outcome of Buccal Mucosal Graft Urethroplasty in Long Segment Anterior Urethral Stricture

Bangladesh Journal of Urology ◽

10.3329/bju.v19i2.49365 ◽

2020 ◽

Vol 19 (2) ◽

pp. 64-68

Author(s):

Mrinmoy Biswas ◽

Sudip Das Gupta ◽

Mohammed Mizanur Rahman ◽

Sharif Mohammad Wasimuddin

Keyword(s):

Urethral Stricture ◽

Flow Rate ◽

Surgical Outcome ◽

Simple Technique ◽

Anterior Segment ◽

Maximum Flow ◽

Anastomotic Site ◽

Buccal Mucosal Graft ◽

Male Patients

Objective: To assess the success of BMG urethroplasty in long segment anterior urethral stricture. Method: From January 2014 to December 2015, twenty male patients with long anterior segment urethral stricture were managed by BMG urethroplasty. After voiding trial they were followed up at 3 month with Uroflowmetry, RGU & MCU and PVR measurement by USG. Patients were further followed up with Uroflowmetry and PVR at 6 months interval.Successful outcome was defined as normal voiding with a maximum flow rate >15ml /sec and PVR<50 ml with consideration of maximum one attempt of OIU after catheter removal. Results: Mean stricture length was 5.2 cm (range 3-9 cm) and mean follow-up was 15.55 months (range 6-23 months). Only two patients developed stricture at proximal anastomotic site during follow-up. One of them voided normally after single attempt of OIU. Other one required second attempt of OIU and was considered as failure (5%). Conclusion: BMG urethroplasty is a simple technique with good surgical outcome. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.64-68

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Outcome of Dorsal Onlay Urethroplasty for Long Segment Anterior Urethral Stricture: Experience of 31 Cases

Bangladesh Journal of Urology ◽

10.3329/bju.v19i1.49339 ◽

2020 ◽

Vol 19 (1) ◽

pp. 28-31

Author(s):

Hafiz Al Asad ◽

Prodyut Kumar Saha ◽

AKM Shahadat Hossain ◽

Md Waliul Islam ◽

Akm Musa Bhuiyan

Keyword(s):

Urethral Stricture ◽

Kidney Diseases ◽

Successful Outcome ◽

Anastomotic Site ◽

Short Term ◽

Term Outcome ◽

Buccal Mucosa Graft ◽

Retrograde Urethrogram ◽

A Prospective Study

Objective: To determine the short-term outcome of dorsolateral onlay urethroplasty in the treatment of long segment anterior urethral stricture. Materials and Methods: A prospective study from May 2011 to September 2012 is carried out in department of Urology, National Institute of Kidney Diseases and Urology, Sher-EBanglanagar, Dhaka. Thirty one patients with long anterior urethral stricture were treated by a dorsolateral onlay buccal mucosa graft. After voiding trial, they were followed up at 3 weeks and 3 months with history, physical examination, uroflowmetry and retrograde urethrogram (RGU) if required (uroflowmetry <15 ml/sec). Patients were further followedup at 3 months interval with uroflowmetry and retrograde urethrogram (RGU) if required (uroflowmetry <15 ml/sec). Successful outcome was defined as normal voiding with no surgical intervention after catheter removal. Results: Mean stricture length was 42.49±12.77 mm (range 24-70 mm) and mean follow up was 8 months (range 6 to 12 months). Three patients were found to develop stricture at anastomotic site, during follow-up and required optical internal urethrotomy and was considered as failure. One patient developed wound infection which resolved after regular dressing. Success rate was 90.32%. Conclusion: Dorsolateral onlay BMG urethroplasty is feasible for long anterior urethral stricture with good short term surgical outcome. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.28-31

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

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v3i1.21 ◽

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.

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Post-Surgical Outcomes of Dorsolateral Onlay Urethroplasty

Anwer Khan Modern Medical College Journal ◽

10.3329/akmmcj.v7i2.31639 ◽

2017 ◽

Vol 7 (2) ◽

pp. 16-19

Author(s):

Chowdhury ATM Mowladad ◽

Khan Mohiur Rahman ◽

Ahmed Bakhtiar ◽

Hassan Rafiqul ◽

Rahman Shofiqur ◽

...

Keyword(s):

Urethral Stricture ◽

Maximum Flow ◽

Vascular Supply ◽

Successful Outcome ◽

Urethral Reconstruction ◽

Medical College ◽

Urethral Strictures ◽

Standard Management ◽

Retrograde Urethrogram ◽

Poor Outcomes

Background: The standard management of urethral strictures involving the anterior urethra is dorsal onlay buccal mucosa augmentation urethroplasty. This requires circumferential mobilisation of the urethra, which might cause ischemia of the urethra in addition to chordee. In this research, we managed the anterior urethral stricture, applying a dorsolateral onlay urethroplasty.Methodology: This prospective study was conducted in the Department of Urology, BIRDEM General Hospital& some private hospitals from July 2009 to June 2015, the outcomes of a total cases of 103 of one sided anterior dorsolateral onlay OMG Urethroplastywere assess and compared. Patients with anterior and recurrent urethral stricture more than 1 cm were included as study population. Urethrogram and Uroflowmetry were the mainstay of assessment. Success was defined as a maximum flow rate of>20 ml/sec., normal RGU, and/or urethroscopy. Poor outcomes were defined as the presence of obstructive urinary tract symptoms, Qmax <15 ml/sec., stricture diagnosed on retrograde urethrogram/ urethroscopy, and the need for any postoperative urethral intervention.Result: Of the 103 patients, 97 had (94.2%) successful outcome and 6 (5.8%) were failure. Four failed cases underwent optical internal urethrotomy and two patients had persistent narrowing and they were managed by BMG Urethroplasty. Follow up period was 12 months on an average. In conclusion, it can be said thatthe preservation of one sided vascular supply to the urethra and its entire muscular and neurogenic support represent significantly towards perfecting the surgical technique of urethral reconstruction using a minimally invasive approach.Conclusion: In this study, we found it to be a technically feasible, easily adoptable and finally successful procedure.Anwer Khan Modern Medical College Journal Vol. 7, No. 2: Jul 2016, P 16-19

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Dorsal Onlay Buccal Mucosal Graft Urethroplasty for Bulbar Urethral Stricture- Experience of 20 Cases

Journal of Dhaka Medical College ◽

10.3329/jdmc.v26i1.33990 ◽

2017 ◽

Vol 26 (1) ◽

pp. 8-11

Author(s):

Hafiz Al Asad ◽

AKM Musa Bhuiyan ◽

Md Nazmul Islam ◽

Uttam Karmaker ◽

Md Shafiqul Alam Chowdhury ◽

...

Keyword(s):

Successful Outcome ◽

Anastomotic Site ◽

Medical College ◽

Urethral Strictures ◽

Buccal Mucosal Graft ◽

Onlay Technique ◽

Retrograde Urethrogram ◽

Dorsal Onlay ◽

Optical Internal Urethrotomy

Objective: To assess the success of buccal mucosal graft (BMG) urethroplasty by the dorsal onlay technique in bulbar urethral stricture.Materials and Methods: From July 2008 to June 2010, twenty patients with anterior urethral strictures were managed by dorsal onlay BMG urethroplasty. After voiding trial, they were followed up at 3 weeks and 3 months with history, physical examination, uroflowmetry and retrograde urethrogram (RGU) if required. Patients were further followed-up at 3 months interval with uroflowmetry and retrograde urethrogram (RGU) if required. Successful outcome was defined as normal voiding with no surgical intervention after catheter removal.Results: Mean stricture length was 3.5 ± 0.8 cm and mean follow up was 12 months (range 6 to 24 months). Two patients were found to develop stricture at anastomotic site, during followup and required optical internal urethrotomy and was considered as failure. One patient developed wound infection which resolved after regular dressing. Success rate was 90%.Conclusion: Dorsal onlay BMG urethroplasty is a simple technique with good surgical outcome.J Dhaka Medical College, Vol. 26, No.1, April, 2017, Page 8-11

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A case series of standard surgical management of bulbo-membranous stricture

International Surgery Journal ◽

10.18203/2349-2902.isj20171131 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1299

Author(s):

Dhananjay Selukar ◽

Amit Narayan Pothare ◽

Kunal Meshram ◽

Vinay Rahangdale ◽

Nikhilesh Jibhkate ◽

...

Keyword(s):

Urethral Stricture ◽

Long Term Results ◽

Tension Free ◽

Urethral Strictures ◽

Buccal Mucosal Graft ◽

Number Of Patients ◽

Duration Of Surgery ◽

End To End ◽

Anastomotic Urethroplasty

Background: Urethral stricture is an acquired permanent narrowing of the urethra impeding the flow of urine during micturition. It is one of the oldest urological diseases, and its treatment remains a challenge for urologists. Urethral stricture disease affects about 300 per 100,000 men. Most common causes are trauma and infections in developing countries and idiopathic in developed countries. Treatment options for short bulbar urethral strictures include dilatation, direct visual internal urethrotomy and anastomotic urethroplasty. Excision and end to end anastomosis (anastomotic urethroplasty) for short bulbo-membranous urethral strictures and buccal mucosal graft gives excellent long term results with reduced recurrence rate.Methods: Sixty-three patients who had undergone anastomotic urethroplasty from 2013 to 2016 at Government Medical College and Superspeciality Hospital, Nagpur, Maharashtra, India Department of Urology were included in the study. For strictures less than 2cm, excision of stricture and anastomosis done, while for stricture more than 2cm buccal mucosal grafting done over 16 F Foleys catheter. Postoperative follow up done up to 1 year.Results: The total number of patients included is 63 and study conducted between January 2013 to December 2016. End to end urethroplasty was done in 41 patients and had mean duration of surgery of about 120 minutes, while buccal mucosal grafting was done in 22 patients. Age ranges from 14 to 78 years with highest incidence of stricture was seen after 5th decade of life, mainly due to iatrogenic causes of previous instrumentation and post TURP surgery. Strictures in younger adults are mainly as a result of trauma by fall astride injury and pelvic fractures and seen during 3rd and 4th decade of life. Most common length of stricture observed was 1-2cm in about 65.07% and mainly occurred due to post urethral procedures. Long strictures more than 2cm were mainly because of trauma in about 35%. Seven patients had recurrence in follow up, out of which 2 managed conservatively by repeated dilatation and 5 patients needed reoperation.Conclusions: The present results suggest that in patients with strictures too long to be excised and re-anastomosed a tension-free buccal mucosal graft provides better results. However, in patients with short strictures, in whom a completely tension-free anastomosis can be achieved, direct end-to-end anastomosis remains good option.

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Buccal mucosal graft urethroplasty for radiation-induced urethral strictures: an evaluation using the extended Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM)

World Journal of Urology ◽

10.1007/s00345-020-03102-5 ◽

2020 ◽

Vol 38 (11) ◽

pp. 2863-2872 ◽

Cited By ~ 2

Author(s):

Malte W. Vetterlein ◽

◽

Luis A. Kluth ◽

Valentin Zumstein ◽

Christian P. Meyer ◽

...

Keyword(s):

Radiation Therapy ◽

Urethral Stricture ◽

Outcome Measure ◽

Patient Reported Outcome ◽

Patient Reported Outcome Measure ◽

Urethral Strictures ◽

Buccal Mucosal Graft ◽

Surgery Patient ◽

Patient Reported ◽

Radiation Induced

Abstract Objectives To evaluate objective treatment success and subjective patient-reported outcomes in patients with radiation-induced urethral strictures undergoing single-stage urethroplasty. Patients and methods Monocentric study of patients who underwent single-stage ventral onlay buccal mucosal graft urethroplasty for a radiation-induced stricture between January 2009 and December 2016. Patients were characterized by descriptive analyses. Kaplan–Meier estimates were employed to plot recurrence-free survival. Recurrence was defined as any subsequent urethral instrumentation (dilation, urethrotomy, urethroplasty). Patient-reported functional outcomes were evaluated using the validated German extension of the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM). Results Overall, 47 patients were available for final analyses. Median age was 70 (IQR 65–74). Except for two, all patients had undergone pelvic radiation therapy for prostate cancer. Predominant modality was external beam radiation therapy in 70% of patients. Stricture recurrence rate was 33% at a median follow-up of 44 months (IQR 28–68). In 37 patients with available USS PROM data, mean six-item LUTS score was 7.2 (SD 4.3). Mean ICIQ sum score was 9.8 (SD 5.4). Overall, 53% of patients reported daily leaking and of all, 26% patients underwent subsequent artificial urinary sphincter implantation. Mean IIEF-EF score was 4.4 (SD 7.1), indicating severe erectile dysfunction. In 38 patients with data regarding the generic health status and treatment satisfaction, mean EQ-5D index score and EQ VAS score was 0.91 (SD 0.15) and 65 (SD 21), respectively. Overall, 71% of patients were satisfied with the outcome. Conclusion The success rate and functional outcome after BMGU for radiation-induced strictures were reasonable. However, compared to existing long-term data on non-irradiated patients, the outcome is impaired and patients should be counseled accordingly.

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