Multi-Institutional Experience With Buccal Mucosa Onlay Urethroplasty for Bulbar Urethral Reconstruction

Kane, Christopher J.; Tarman, Gregory J.; Summerton, Duncan J.; Buchmann, Craig E.; Ward, John F.; O’Reilly, Keith J.; Ruiz, Henry; Thrasher, J. Brantley; Zorn, Burk; Smith, Carolyn; Morey, Allen F.

doi:10.1016/s0022-5347(05)65289-5

Cited by 129 publications

(51 citation statements)

References 19 publications

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“…Primary end-to-end anastomosis is suggested for stricture less than 2 cm as it has the highest chance of success (>90%) [12,19]. However, with longer stricture, the impact of urethral shortening on penile curvature during erection becomes a major concern and so it becomes necessary to carry out a substitution technique [10]. When considering the substitution urethroplasty, there are two main issues in the current controversy: the use of oral mucosa versus penile skin and the use of dorsal versus ventral placement of the graft or flap [20].…”

Section: Discussionmentioning

confidence: 99%

“…Of these free grafts, buccal mucosa has emerged as one of the most reliable and popular grafts for patch urethroplasty because of its unique physical characters, as it is hairless and easy to harvest [7][8][9]. In addition, oral mucosa has immunological properties similar to those of the urothelium, making it less prone to infection [8,10].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dorsal onlay urethroplasty using buccal mucosa graft versus penile skin flap for management of long anterior urethral strictures: a prospective randomized study

Soliman¹,

Farha²,

El-Abd³

et al. 2014

Scandinavian Journal of Urology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dorsal onlay urethroplasty using buccal mucosa graft versus penile skin flap for management of long anterior urethral strictures: a prospective randomized study

Soliman¹,

Farha²,

El-Abd³

et al. 2014

Scandinavian Journal of Urology

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“…Buccal mucosa has emerged as a reliable free graft for repairing bulbar urethral strictures that are not amenable to primary anastomosis, with reported stricture-free rates ranging from 89-100% 5-9 . Despite theoretical advantages of dorsal (compared to ventral) grafts, such as a more stable and reliably well vascularized recipient bed, attempts at identifying optimal position of the graft have been inconclusive.…”

Section: Discussionmentioning

confidence: 99%

Impact of Graft Position on Failure of Single-stage Bulbar Urethroplasties With Buccal Mucosa Graft

Figler

Malaeb

et al. 2013

Urology

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OBJECTIVE To determine whether patency rates after bulbar urethroplasty with buccal mucosa graft onlay differ based on whether the graft is placed ventrally or dorsally. METHODS This was a retrospective, single-center study of all single-stage bulbar urethroplasties performed from 2001- 2011 by two surgeons in which buccal mucosa was used as an onlay graft. Failure was defined as the need for endoscopic or open revision of the reconstruction, or placement of a suprapubic catheter for urinary retention. RESULTS A total of 103 patients were reviewed; 41 underwent dorsal onlay, and 62 underwent ventral onlay. Mean age was 40.8 years. Most (84%) patients underwent a prior procedure, which consisted of DVIU in 69%, dilation in 53%, and urethroplasty in 14%. Mean stricture length was 3.9cm. At a mean follow-up of 36 months, failure occurred in 19 patients (12 ventral, 7 dorsal). The vast majority of these patients (79%) were successfully treated with a single dilation or DVIU. There was no difference in failure rate or time to failure according to whether graft position was ventral or dorsal. In multivariate analysis, diabetes was predictive of failure (OR 8.7, 95% CI 1.6-46.5, p = 0.01). CONCLUSIONS Single-stage bulbar urethroplasty with buccal mucosa graft is an effective procedure for patients with a bulbar urethral stricture that is not amenable to primary anastomosis. From our experience, we cannot conclude that dorsal or ventral graft position is inherently superior. Patients with diabetes may be more likely to require additional procedures following bulbar urethroplasty with buccal grafting.

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“…Facial swelling and restrictions in mouth opening are common, but are self-limiting and will resolve within the first 3 months. [2243742]…”

Section: Complicationsmentioning

confidence: 99%

Buccal mucosa urethroplasty for adult urethral strictures

Zimmerman

Santucci

2011

Indian J Urol

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Urethral strictures are difficult to manage. Some treatment modalities for urethral strictures are fraught with high patient morbidity and stricture recurrence rates; however, an extremely useful tool in the armamentarium of the Reconstructive Urologist is buccal mucosal urethroplasty. We like buccal mucosa grafts because of its excellent short and long-term results, low post-operative complication rate, and relative ease of use. We utilize it for most our bulbar urethral stricture repairs and some pendulous urethral stricture repairs, usually in conjunction with a first-stage Johanson repair. In this report, we discuss multiple surgical techniques for repair of urethral stricture disease. Diagnosis, evaluation of candidacy, surgical techniques, post-operative care, and complications are included. The goal is to raise awareness of buccal mucosa grafting for the management urethral stricture disease.

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Multi-Institutional Experience With Buccal Mucosa Onlay Urethroplasty for Bulbar Urethral Reconstruction

Abstract: Buccal mucosa grafts used as a ventral onlay for bulbar urethral reconstruction yield reproducibly excellent results with minimal morbidity and low complication rates. Longer followup will be required to confirm the durability of our results.

Cited by 129 publications

References 19 publications

Dorsal onlay urethroplasty using buccal mucosa graft versus penile skin flap for management of long anterior urethral strictures: a prospective randomized study

Dorsal onlay urethroplasty using buccal mucosa graft versus penile skin flap for management of long anterior urethral strictures: a prospective randomized study

Impact of Graft Position on Failure of Single-stage Bulbar Urethroplasties With Buccal Mucosa Graft

Buccal mucosa urethroplasty for adult urethral strictures

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