Dorsal Onlay versus Ventral Onlay Urethroplasty for Anterior Urethral Stricture: A Meta-Analysis

Abstract

Background: Ventral and dorsal sides of urethra were chosen to place grafts in free graft onlay urethroplasty. As the advantages and disadvantages of these two sites are still unclear, we systemically analyzed clinical articles reported in the literature. Materials and Methods: The literature till October 2007 regarding the use of ventral/dorsal graft urethroplasty in anterior urethral strictures was searched using the MEDLINE, Cochrane Library, and EMBASE databases. ‘Urethral stricture’ or ‘urethral stenosis’ and ‘urethroplasty’ or ‘urethral reconstruction’ were used as search terms. Data were analyzed independently by two reviewers. Results: 49 studies (1,263 cases) were included. The success rates of ventral onlay urethroplasty (750 cases) and dorsal onlay (513 cases) were 82.5 and 86.9% (p = 0.034). Buccal mucosa graft had the highest success rate (88.1%) and had a similar rate between the dorsal and ventral onlay techniques (89.2 vs. 87.6%, p = 0.472). For free skin graft, the dorsal onlay success rate was higher than ventral (84.7 vs. 74.7, p = 0.016). Bulbar urethral stricture achieved the higher success rate than pendulous urethral stricture (87.4 vs. 77.6%, p = 0.019). Conclusions: Dorsal onlay is better than ventral onlay in free skin graft urethroplasty. Bulbar urethra is the most suitable site for graft onlay urethroplasty, and buccal mucosa graft is helpful for achieving good results.

Anterior Urethral Strictures: A Brief Review of the Current Surgical Treatment

“…Further, the complications associated with the ventral onlay technique in series with longer follow-up tend to be more prevalent [43]. Most recently, Wang et al [44] performed a meta-analysis review of the literature on dorsal or ventral graft urethroplasty. The success rates of ventral onlay urethroplasty (750 cases) and dorsal onlay (513 cases) were 82.5 and 86.9% (p = 0.034).…”

Tratamiento reconstructivo de la estenosis uretral femenina secundaria a erosión por cinta suburetral

“…No se registró complicación alguna relacionada con la reparación. La estancia media hospitalaria fue 2,3 (1-5) días y el tiempo de mantenimiento postoperatorio del catéter (22 Ch) de 12,3 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) días. Las pacientes fueron evaluadas tras la cirugía con un seguimiento medio de 34,3 (12-55) meses, encontrándose sin incontinencia, sin síntomas obstructivos y con resultados cosméticos y funcionales (residuo, flujo máximo) satisfactorios (tabla 1).…”

“…Lo mismo puede decirse si se planifica una reconstrucción basada exclusivamente en el empleo de otro tipo de colgajos (vestíbulo vaginal, labio menor) 16,17 o de injertos libres de mucosa oral 18,19 . El problema de este tipo de técnicas es que no refuerzan, sino que, al contrario, debilitan la pared vaginal anterior.…”

Does site of buccal mucosa graft for bulbar urethra stricture affect outcome? A comparative analysis of ventral, dorso-lateral and dorsal buccal mucosa graft augmentation urethroplasty

“…On review of literature it was found that both dorsal and ventral BMG augmentation urethroplasties were associated with similar outcomes (Table 2). [9][10][11][12] Proponents of dorsal placement of graft argue that there is decreased chance of diverticula formation and better chance of neovascularisation with the graft lying on cavernosal bodies which would not be seen if the graft is placed ventrally. The proponents of ventral placement in bulbar urethra argue that it offers better access to proximal site of stricture, less mobilization of urethra preserving its vascularity in addition to the fact that the bulbocavernous muscle prevents diverticula formation.…”