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

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

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

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

scholarly journals Prostate-Specific Antigen Velocity Predicts Surgical Outcome of Thulium Laser Enucleation of the Prostate

2022 ◽  
Vol 8 ◽  
Author(s):  
Po-You Chen ◽  
Shao-Ming Chen ◽  
Horng-Heng Juang ◽  
Chen-Pang Hou ◽  
Yu-Hsiang Lin ◽  
...  
Keyword(s):  
Prostate Specific Antigen ◽  
Surgical Outcome ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Area Under The Curve ◽  
Maximum Flow ◽  
Thulium Laser ◽  
Laser Enucleation ◽  
Male Patients

Background: We determined the effect of prostate-specific antigen velocity (PSAV) on the surgical outcome of thulium laser enucleation of the prostate (ThuLEP) in patients with benign prostatic hyperplasia (BPH).Methods: A retrospective review was performed of prospectively collected data of patients with BPH who underwent ThuLEP at any time from 2017 to 2019. Patients who had undergone BPH surgery or had prostate cancer previously were excluded, and patients with prostate-specific antigen (PSA) &gt; 4 ng/ml were examined through transrectal ultrasound-guided prostate biopsy to rule out prostatic malignancy. Furthermore, patients were excluded if prostatic malignancy was diagnosed during postsurgery follow-up.Results: The PSA level, International Prostate Symptom Score (IPSS), and quality of life (QoL) of 27 male patients at 3 and 15 months postsurgery differed significantly from those at presurgery; the maximum flow rate (Qmax) and postvoid residual (PVR) significantly differed between 3 months postsurgery and presurgery; and 22 and 5 patients had good to excellent and fair to poor outcomes, respectively, at 15 months postsurgery. Patients were divided into two groups (fair and poor vs. good and excellent outcomes at 15 months postsurgery), which significantly differed with respect to PSAV at 3 months postsurgery (P = 0.04), IPSS presurgery (P &lt; 0.02), surgical length (P = 0.01), and hospitalization duration (P = 0.04). In a receiver operating characteristic (ROC) analysis, the optimal cutoff value of PSAV of −0.52 ng/ml characterized effectiveness at 15 months after ThuLEP, and the area under the curve (AUC), sensitivity, and specificity were 0.82 (P &lt; 0.02), 0.80, and 0.82, respectively. For PSAV &lt; -0.52 and ≥-0.52 ng/ml, the percentages of reduction for IPSS, QoL, Qmax, and PVR were −78.6 and −71.4%, −33.3 and 0.0%, 94.4 and 40.0%, and −85.1 and −38.7%, respectively.Conclusions: Postsurgical PSAV was positively correlated with surgical success, and the PSAV cutoff was −0.52 ng/ml. PSAV can, thus, be used to guide the postsurgical follow-up treatment at 3 months after BPH surgery.

Outcome of Dorsolateral OnlAy OMG Urethroplasty for Anterior Urethral Stricture

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

scholarly journals Dorsal Onlay Buccal Mucosal Graft Urethroplasty for Bulbar Urethral Stricture- Experience Of 20 Cases

2015 ◽  
Vol 23 (2) ◽  
pp. 175-178
Author(s):  
Hafiz Al Asad ◽  
AKM Musa Bhuiyan ◽  
Md Nazmul Islam ◽  
Uttam Karmaker ◽  
Md Shafiqul Alam Chowdhury ◽  
...  
Keyword(s):  
Simple Technique ◽  
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: FromJuly 2008 to June 2010, twenty patients with anterior urethral strictures weremanaged by dorsal onlay BMG urethroplasty. After voiding trial, they were followed up at 3 weeksand 3 months with history, physical examination, uroflowmetryand retrograde urethrogram (RGU) if required. Patients were furtherfollowed-up at 3 months interval with uroflowmetry and retrograde urethrogram (RGU) if required. Successfuloutcome 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). Twopatients 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. 23, No.2, October, 2014, Page 175-178

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.

scholarly journals A Comparative Study of Dorsal Buccal Mucosa Graft Substitution Urethroplasty by Dorsal Urethrotomy Approach versus Ventral Sagittal Urethrotomy Approach

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Mrinal Pahwa ◽  
Sanjeev Gupta ◽  
Mayank Pahwa ◽  
Brig D. K. Jain ◽  
Manu Gupta
Keyword(s):  
Flow Rate ◽  
Operative Time ◽  
Imaging Study ◽  
Maximum Flow ◽  
Maximum Flow Rate ◽  
Residual Urine ◽  
Buccal Mucosa Graft ◽  
Buccal Mucosal Graft ◽  
Significant Difference ◽  
The Difference

Objectives. To compare the outcome of dorsal buccal mucosal graft (BMG) substitution urethroplasty by dorsal urethrotomy approach with ventral urethrotomy approach in management of stricture urethra.Methods and Materials. A total of 40 patients who underwent dorsal BMG substitution urethroplasty were randomized into two groups. 20 patients underwent dorsal onlay BMG urethroplasty as described by Barbagli, and the other 20 patients underwent dorsal BMG urethroplasty by ventral urethrotomy as described by Asopa. Operative time, success rate, satisfaction rate, and complications were compared between the two groups. Mean follow-up was 12 months (6–24 months).Results. Ventral urethrotomy group had considerably lesser operative time although the difference was not statistically significant. Patients in dorsal group had mean maximum flow rate of 19.6 mL/min and mean residual urine of 27 mL, whereas ventral group had a mean maximum flow rate of 18.8 and residual urine of 32 mL. Eighteen out of twenty patients voided well in each group, and postoperative imaging study in these patients showed a good lumen with no evidence of leak or extravasation.Conclusion. Though ventral sagittal urethrotomy preserves the blood supply of urethra and intraoperative time was less than dorsal urethrotomy technique, there was no statistically significant difference in final outcome using either technique.

scholarly journals Outcome of One Stage Urethroplasty Using Buccal Mucosa for Long Segment Urethral Stricture

2020 ◽  
Vol 18 (2) ◽  
pp. 68-73
Author(s):  
Md Sirajul Islam ◽  
Md Faisal Islam ◽  
Anamur Rashid Choudhury ◽  
Sarforaj Ali Khan ◽  
Pranashis Saha
Keyword(s):  
Retrospective Study ◽  
Physical Examination ◽  
Urethral Stricture ◽  
Buccal Mucosa ◽  
Private Hospital ◽  
One Stage ◽  
Buccal Mucosal Graft ◽  
The Mean

Objective: To assess the outcome of one stage urethroplasty using buccal mucosa for long segment (>2cm) urethral stricture. Material & Method: This retrospective study was done in a private Hospital at Jessore from May, 2010 to October, 2012. Twenty nine patients were managed with one stage dorsal on lay buccal mucosal graft (BMG). Patients were followed up 3 monthly with history, physical examination and relevant investigations. The mean duration of follow up was 23 months. Result: The age of the patients ranged from18 years to 65 years with mean of 35years. The length of the stricture ranged from 2.5cm to 10 cm with mean length 5.5 cm. The mean duration operative period was 3.5 hours with range from 2 hours to 4.5 hours. Of the 29 patients, 15 patients (51.7%) had bulbar urethral stricture, 10 patients (34.5%) had penile urethral stricture and 4 patients (13.8) had pan urethralstricture. Success was defined as normal voiding without further procedure. The rate of recurrence noted in this study was 10.34%. Conclusion: One stage dorsal on lay BMG urethroplsaty is a reliable and satisfactory procedure for the management of long segment urethral stricture with minimum complication. Bangladesh Journal of Urology, Vol. 18, No. 2, July 2015 p.68-73

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

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

scholarly journals Buccal Mucosal Graft Urethroplasty as Primary Repair Has Significantly Better Outcome Than After Failed Dviu Cases- a Clinical Trial

2020 ◽  
Vol 21 (1) ◽  
pp. 3-7
Author(s):  
Hasina Sadia Khan ◽  
AKM Anwarul Islam ◽  
AKM Khurshidul Alam ◽  
Mohammad Salahuddin Faruque ◽  
Ismat Jahan ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Urethral Stricture ◽  
Flow Rate ◽  
Primary Repair ◽  
Urine Flow ◽  
Control Group ◽  
Study Group ◽  
Short Segment ◽  
Buccal Mucosal Graft ◽  
Stricture Recurrence

Introduction: Direct Visual Internal Urethrotomy (DVIU) is the most commonly used technique for short segment bulbar urethral stricture till date. But it has a high failure and recurrence rate. On the other hand, urethroplasty is regarded as the gold standard treatment for urethral stricture. Moreover, for bulbar urethral stricture, usually more than 3cm stricture are treated with substitution urethroplasty. Current practice for short segment bulbar urethral stricture is multiple sessions of DVIU and then buccal mucosal graft (BMG) urethroplasty if they fail. But repeated DVIU make the stricture segment longer and more fibrotic. Considering the morbidities following repeated DVIU, this prospective clinical trial has been designed to compare the outcome of BMG urethroplasty after failed urethrotomy versus primary repair. Objective: To determine stricture recurrence, PVR and flow of urine in between primary BMG urethroplasty group and after failed DVIU group. Patients and Methods: The present study was conducted in the department of Urology, BSMMU between July’15 - February’17. Patients of short segment bulbar urethral stricture between 1.5- 3 cm without any previous DVIU were enrolled as study group(n=22) and patients with history of failed DVIU were included as control group(n=22). All the patients were followed upto 12 months after BMG urethroplasty and recurrence of stricture (by RGU and MCU), PVR and maximum urine flow rate (Qmax) in between two groups were compared. Results: The stricture recurrence rate was found significantly higher in control group than in the study group (p=0.042). The study group showed highly significant (0.000) decrease in post-operative PVR and significant (0.009) increase in post operative maximum urine flow rate than the control group as was assumed in the hypothesis. Conclusion: The present study propose that BMG urethroplasty as primary repair for bulbar urethral stricture within a length of 1.5-3 cm in younger age group (upto 45 years ) is very effective than BMG urethroplasty after failed DVIU cases. But long term multicentric trial is needed to further comment. Bangladesh Journal of Urology, Vol. 21, No. 1, January 2018 p.3-7

scholarly journals Dorsolateral Onlay Urethroplasty for the Long Segment Anterior Urethral Stricture: Outcome of 31 Cases

2020 ◽  
Vol 18 (1) ◽  
pp. 12-15
Author(s):  
Hafiz Al Asad ◽  
Md Sharif Shahjamal ◽  
Sarforaj Ali Khan ◽  
Md Waliul Islam ◽  
AKM Zamanul Islam Bhuiyan
Keyword(s):  
Urethral Stricture ◽  
Kidney Diseases ◽  
Successful Outcome ◽  
Anastomotic Site ◽  
Short Term ◽  
Buccal Mucosa Graft ◽  
Retrograde Urethrogram ◽  
A Prospective Study ◽  
Optical Internal Urethrotomy

Objective: This study is designed to observe the short-term outcomes of dorsolateral onlay urethroplasty to treat 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. 18, No. 1, Jan 2015 p.12-15

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