Long-term Outcomes of Single Stage Dorsal Onlay Buccal Mucosa Urethroplasty for Different Anterior Urethral Strictures: A prospective Study

Abstract

Objective: To report detailed technique and results of one stage dorsal onlay buccal mucosa graft for repair of anterior urethral strictures. Patients and methods: A total of 45 males with anterior urethral stricture ≥ 2.5 cm not amenable for excision and primary anastomosis. All patients underwent one-stage dorsal onlay buccal mucosa urethroplasty. Their ages ranged from 14 to75 years (mean of 35.5 yr). A successful outcome means normal voiding pattern without any post-operative intervention. Results and limitations: The stricture was iatrogenic in 15 (33.3%) cases, idiopathic in 12 (26.7%), traumatic in 10 (22.2%) cases, and post inflammatory in 8 (17.8%) cases. The mean operative time was 158 minutes. The mean stricture length was 5.6 cm (range: 2.5-16 cm), while, the mean graft length was 7.2 cm (range: 4.5-18cm). The mean follow-up period was 36 months (range 27-48). Overall success rate was 88.9% (40/45). Four patients developed stricture Recurrence. Two of them had annular short bulbar stricture for which direct vision internal urethrotomy was performed and the other two cases needed redo urethroplasty. One patient had dehiscence of glans penis after repair of pan urethral stricture and repair was required. This case and the previous four cases were considered failures (11.1%). The most common complication was urinary tract infection (24.4%). All patients returned to normal diet within 48 hours without oral complications. Conclusion: Meticulous repair of anterior urethral strictures using dorsal onlay buccal graft is technically easy with high success rate. Buccal graft harvesting is simple and easy procedure.

Factors Predicting Urethral Stricture Recurrence after Dorsal Onlay Augmented, Buccal Mucosal Graft Urethroplasty

“…The one-stage dorsal onlay urethroplasty using BMG has a high overall success rate, and it is considered an excellent treatment option for the most of long-segment anterior urethral strictures [7]. In the current series, the reported recurrence-free rate was 87.2% at an average follow-up period of 49.77 months.…”

“…Since the description of dorsal onlay free graft urethroplasty by Barbagli and his colleagues [5], the procedure has gained universal application for the treatment of penile and bulbar urethral strictures [6, 7]. Currently, the buccal mucosal graft (BMG) is the most commonly used graft for substitution urethroplasty due to its favorable availability, effortless harvesting, and durable integration in the urethra [6-9].…”

“…Despite the high urethral patency rate after urethroplasty [7, 14, 15], about 10% of cases develops stricture recurrence and require further management. Until now, there is a discrepancy in the literature regarding risk factors for stricture recurrence after urethroplasty.…”