Buccal mucosa urethroplasty for adult urethral strictures

Zimmerman, W. Britt; Santucci, Richard A.

doi:10.4103/0970-1591.85441

Cited by 35 publications

(24 citation statements)

References 25 publications

(35 reference statements)

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“…Following BMG urethroplasty, many urologists discharge their patients anytime from the 2 nd day postoperative. 9 14 The long duration of hospital stay was as a result of the adverse preoperative conditions such as DM and dental caries in this study. Some of the patients, particularly the older men, requested for a longer hospital stay because of anticipated inability to care for their oral and perineal wounds at home.…”

Section: Discussionmentioning

confidence: 72%

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Buccal mucosal graft urethroplasty for proximal bulbar urethral stricture: A revisit of the surgical technique and analysis of eleven consecutive cases

et al. 2016

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Background:Urethral stricture disease is prevalent, and many surgical techniques have been developed to treat it. Currently, urethroplasty for bulbar strictures implies ventral or dorsal stricturotomy and a buccal mucosa graft (BMG) patch.Objective:To describe the surgical approach of the ventral patch BMG urethroplasty for proximal bulbar urethral stricture and to analyze 11 consecutive cases for whom the technique was used.Patients and Methods:The diagnosis of urethral stricture was confirmed with a combined retrograde urethrography and micturating cystourethrography. A single team exposed the urethra, harvested, and planted the BMG in the lithotomy position under general anesthesia. The oral preoperative preparation was done with oraldene (hexetidine) mouth wash three times daily beginning from the 2nd preoperative day. The buccal mucosa was harvested from the left inner cheek in all the patients. The donor site was left unclosed but packed with wet gauze. Data related to age, preoperative adverse conditions, stricture length, urine culture result, perineal/oral wound complications, postoperative residual urine volume, and duration of hospital stay were recorded.Results:Eleven patients with proximal bulbar urethral stricture had BMG urethroplasty from August 2013 to October 2015. Stricture length ranged from 2 to 5 cm. In six (54%) of the men, the stricture resulted from urethritis thereby constituting the most common etiology of urethral stricture in this study. The preoperative adverse conditions were age above 70 in three, diabetes mellitus in two, severe dental caries in one, and recurrent stricture in two. All of them were able to resume reasonable oral intake 72 h postoperatively. One (9.2%) had perineal wound infection, while two (18.2%) still had mild pain at donor site 4 weeks postoperatively. Ten (90.9%) of the 11 patients had <30 ml residual urine volume at 2 months of follow-up.Conclusion:Urethritis is still a common cause of urethral stricture in this rural community. Ventral onlay buccal mucosal graft urethroplasty for proximal bulbar urethral stricture is safe, even in certain adverse preoperative conditions. Buccal mucosa from the cheek is however now preferred.

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Section: Discussionmentioning

confidence: 72%

“…However, many of the modalities are fraught with high patient morbidity and stricture recurrence. 9 Resection and spatulated end-to-end anastomosis is being gradually disfavored by many reconstructive urologists, while the lip is no longer regarded as a good donor site. 10 …”

Section: Discussionmentioning

confidence: 99%

Buccal mucosal graft urethroplasty for proximal bulbar urethral stricture: A revisit of the surgical technique and analysis of eleven consecutive cases

et al. 2016

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“…89,92 Some practitioners favour dorsal placement of grafts throughout the bulbar urethra, whereas others only use dorsal placement in the distal or mid- bulbar urethra, preferring to place ventral grafts proximally where the corpus spongiosum is thickest. Proponents for ventral grafting argue that the technique is technically easier and requires less dissection and mobilization of the urethra than dorsal grafting.…”

Section: Managementmentioning

confidence: 99%

Male urethral strictures and their management

2013

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Male urethral stricture disease is prevalent and has a substantial impact on quality of life and health-care costs. Management of urethral strictures is complex and depends on the characteristics of the stricture. Data show that there is no difference between urethral dilation and internal urethrotomy in terms of long-term outcomes; success rates range widely from 8–80%, with long-term success rates of 20–30%. For both of these procedures, the risk of recurrence is greater for men with longer strictures, penile urethral strictures, multiple strictures, presence of infection, or history of prior procedures. Analysis has shown that repeated use of urethrotomy is not clinically effective or cost-effective in these patients. Long-term success rates are higher for surgical reconstruction with urethroplasty, with most studies showing success rates of 85–90%. Many techniques have been utilized for urethroplasty, depending on the location, length, and character of the stricture. Successful management of urethral strictures requires detailed knowledge of anatomy, pathophysiology, proper patient selection, and reconstructive techniques.

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“…Furthermore, it has a thin lamina propria making it more receptive to expeditious neovascularization. [ 35 36 ] From a technical standpoint, it can be easily harvested with minimal morbidity and thus characterizes a safe procedure with high patient satisfaction. [ 37 ]…”

Section: Disease Managementmentioning

confidence: 99%