Outcome of staged buccal mucosal graft for repair of long segment anterior urethral stricture

Abstract

Background Long anterior urethral stricture due to variable etiological factors constitutes a challenge for reconstruction. We evaluated our centers experience with cases of long anterior urethral stricture due to different etiologies that were managed by 2-stage substitution urethroplasty using buccal mucosal graft procedure. Methods During the period between November 2009 and November 2016. All cases with long anterior urethral stricture that were planned for substitution urethroplasty in our department were enrolled in this study. The first stage was excision of most fibrotic areas of the urethral plate, the remaining of the urethra is laid open and augmented with buccal mucosal graft for second stage closure after 6–9 months. Results The study included 123 patients who underwent first stage, 105 patients of them underwent second stage urethroplasty. Eighteen cases were missed after first stage. The mean (range) age was 38.4 (17–60 years). The mean (range) stricture length was 8.3 (4–13 cm). The cause of stricture was idiopathic in 47, inflammatory in 15, lichen sclerosus in 26 and post failed hypospadias repair in 35 patients. First stage was complicated by graft contracture in 11 (8.9%) patients that needed re-grafting, 5(4.1%) patient had bleeding from the buccal mucosa site that needed haemostatic sutures, oral numbness was reported in 7 (5.7%) patients. Second stage was complicated by wound dehiscence in 2(1.9%) patients, restricture in 11 (10.5%), fistula in 6 (5.7%) patients, meatal stenosis in 3 (2.9%). The overall success rate was 79.1% (83 cases out of 105) with a mean (range) follow-up of 34.7 (10–58 months). Conclusions Staged urethroplasty using buccal mucosal graft procedure is an effective surgical option for patients with long anterior urethral strictures especially for patients with lichen sclerosus and those with failed previous surgical repair.

Triangular extension of hinge flaps: A novel technique to resolve stomal stenosis and prevent restenosis in staged buccal mucosal urethroplasty

“…The key points in the first‐stage surgery are opening of the scarred urethra until the healthy urethra is reached to ensure complete engraftment in the region near the stoma, and to carefully create the stoma by suturing graft to the skin 19 . Even if the first‐stage surgery is perfectly carried out in this manner, it is not uncommon to encounter stomal stenosis caused by annular contracture 2,7,23 . Recent studies reported that after the first‐stage surgery, revision surgery is required in 6.7–59% of patients to repair contracture and/or stomal stenosis 2,3,7,11,13 .…”

Appendicular Mucosal Tube Implant with Dartos Wrap Operation for Hypospadias

“…The penile complications in a series of buccal mucosa urethroplasty [7] was, wound dehiscence in 2 (1.9%) patients, re-stricture in 11 (10.5%), fistula in 6 (5.7%) patients, meatal stenosis in 3 (2.9%).…”

Evaluation of the Extent of Primary Buccal Mucosal Graft Contracture in Augmentation Urethroplasty for Stricture Urethra: A Prospective Observational Study at a Tertiary Healthcare Centre

“…e properties of buccal mucosa such as the absence of hair follicle, highly vascular lamina propria promoting early in growth, wet environment compatibility [12], and ease of harvest with a concealed donor site scar makes it a near ideal substitute for urethra. e incidence of graft contracture in BMG urethroplasty varies from 3 to 22.5% in various studies [13][14][15][16][17][18]. Oral mucosal grafts are also used in the ocular reconstructive Advances in Urology surgeries [19].…”