A novel composite two-stage urethroplasty for complex penile strictures: A multicenter experience

Abstract

Introduction:Complex penile strictures are usually repaired using a two-stage urethroplasty. Buccal mucosal graft (BMG) placed in the first stage can have a significant contraction rate, which may require a subsequent revision surgery. We describe a composite two-stage penile urethroplasty using BMG for patients of complex penile strictures who have some salvageable urethral plate.Methods:Within a multi-institutional cohort, 82 patients underwent a two-stage urethroplasty for complex stricture of the penile urethra. Of these 42 patients who underwent our composite two-stage penile urethroplasty using BMG implanted at the second-stage were included. Patients with genital lichen sclerosus or incomplete clinical records were excluded from this study. The primary outcome of the study was to evaluate stricture-free success rate.Results:Of total 42, 4 patients were lost to follow-up. 42% of stricture etiology was failed hypospadias repair. Mean stricture length was 4.5 cm (range 3–8 cm). Seventeen (44.7%) patients had undergone the previous urethroplasty. At a median follow-up of 44 months, of 38 patients, 34 (89.5%) were successful, and 4 (10.5%) had a recurrence. No patient required revision surgery before the second-stage and required redo buccal graft harvesting for subsequent urethroplasty.Conclusions:The composite two-stage technique in repairing complex penile urethral strictures is a valid and reproducible surgical treatment for complex penile stricture and it may reduce the rate of contraction of the transplanted BMG.

Single‐stage repair of obliterated anterior urethral strictures using buccal mucosa graft and dorsal penile skin flap

“…All attributes of every urethral stricture should be precisely defined to obtain an adequate approach and, subsequently, to achieve a successful outcome. Penile and bulbar urethral strictures with salvageable urethral mucosa and relatively healthy spongy tissue could be successfully repaired using either a buccal mucosa graft or penile skin flap, whereas complex non‐obliterative urethral strictures often required a staged approach . In our center, patients with anterior urethral strictures, where a viable strip of urethral mucosa can be found, are usually repaired by standardized buccal mucosa graft augmentation urethroplasty …”

“…Penile and bulbar urethral strictures with salvageable urethral mucosa and relatively healthy spongy tissue could be successfully repaired using either a buccal mucosa graft or penile skin flap, whereas complex non-obliterative urethral strictures often required a staged approach. [6][7][8][9] In our center, patients with anterior urethral strictures, where a viable strip of urethral mucosa can be found, are usually repaired by standardized buccal mucosa graft augmentation urethroplasty. 10,11 In contrast, the approach is much more questionable in patients with complex obliterative urethral strictures.…”

Redo hypospadias surgery: current and novel techniques

“…When the Bracka procedure was assessed in the UK, the graft contraction rate was 3%, but when the same procedure was done in Middle East, a graft contraction rate of 39% was observed. 10 – 12 …”

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“…Mitash et al . [ 3 ] review the role of cellular metabolic regulatory molecules, such as micro-RNA, which can be used as biomarkers to prognosticate or as targeted therapy for bladder cancer.…”