A one‐stage dorsal free‐graft urethroplasty for bulbar urethral strictures

Abstract

Objective To report the use of a one‐stage dorsal free‐graft urethroplasty to reduce the incidence of urethrocele. Patients and methods From 1990 to 1994, 20 men (age range 21–86 years) underwent a one‐stage dorsal free‐graft urethroplasty of bulbar urethral strictures (iatrogenic in 12, traumatic in three, inflammatory in three and unknown in two). All patients except one had been treated previously by optical urethrotomy from one to 14 times. Results Temporary fistulae were detected on post‐operative urethrography in three patients with particularly long grafts, but they all resolved spontaneously. Within a mean follow‐up of 46 months, only one patient had a short recurrent stricture, which was treated successfully by optical urethrotomy. Two patients complained of post‐voiding dribbling, but radiographic studies never showed graft weakening and the urinary flow rate was always >14 mL/s. Conclusion Free skin grafts can be applied successfully to the dorsal aspect and by doing so the complications of urethral reconstruction can be reduced.

616 Long term results of lingual mucosal grafts for repairing long anterior urethral strictures

“…These include peri-oral paraesthesia, difficulty in opening the mouth due to scar contracture, and Stensen's duct injury [7,8]. However, Barbagli et al [14], in a recent retrospective study, reported that BMG harvesting is safe and associated with minimal short-and long-term morbidity.…”

“…Urethroplasty was performed using a ventral onlay technique in eight patients (five had a proximal bulbar stricture, two were obese, and one had a previous dorsal onlay urethroplasty) and dorsal onlay (Barbagli) technique [7] in the remaining 15. In the ventral onlay technique, the strictured urethra was incised ventrally, extending the incision distally and proximally into the normal urethra.…”

Approach to bulbar urethral strictures: Which technique and when?

“…This method can be achieved by two well-known techniques, which are called Barbagli [4] circumferential mobilization of the urethra, and Kulkarni [10] one side dissection.…”

“…[2,3] Until now, various surgical techniques and approaches with or without buccal mucosal graft (BMG) have been defined for bulbar urethroplasty operations performed for bulbar uretral strictures. Most commonly used techniques include dorsal onlay, [4] ventral onlay, [5] Asopa dorsal inlay, [6] double-face with BMG, and non-transaction anastomotic urethroplasty, in addition to end-to-end anastomosis. [7] There are still some controversies in the current practices of bulbar urethral surgery about the use of oral mucosa, grafting versus anastomotic repair, use of dorsal versus ventral placement of the graft and surgical options for patients with failed hypospadias repair.…”

Ventral Onlay Buccal Mucosal Graft Urethroplasty Based on Tunica Vaginalis Flap for Balanitis Xerotica Obliterans Related Urethral Strictures: The Outcome of Single- Stage Reconstruction

“…15 Barbagli et al and Iselin and Webster have advocated dorsal free grafts for the following theoretical reasons: less bleeding, better graft take, and reduced incidence of diverticulum formation. 16,17 Ventral onlay urethroplasty provides easy exposure of the stricture, an excellent graft bed, and long-term, stricture-free outcomes equal to dorsal onlay, however.…”