Tunica albuginea urethroplasty for anterior urethral strictures: A urethroscopic analysis

Abstract

Objective: To assess the efficacy of tunica albuginea urethroplasty (TAU) for anterior urethral strictures. Methods:We assessed 206 patients with anterior urethral strictures who underwent TAU. The procedure involves mobilization of strictured urethra and laying it open with a dorsal slit. Edges of the slit-open urethra are sutured to edges of the urethral groove with a silicon catheter in situ. Thus in neourethra, the roof is formed by tunica albuginea of the urethral groove. Results were assessed at 6, 12, 24 and 36 months by comparative analysis of patient satisfaction along with retrograde urethrogram, urethrosonogram, uroflowmetry, and were categorized as good , fair and poor. Good and fair results were considered as successful. Thirty patients were taken for postoperative urethroscopic analysis to allow better understanding of both successful and failed cases. Results: Postoperative evaluation at 6 months showed a 96.6% success rate, which decreased to 94.7% at 1 year, 93.2% at 2 years and over 90% at the end of 3 years. The overall failure rate was 9.2%, which required revision surgery. Urethroscopic visualization of the reconstruction site showed wide, patent and distensible neourethra uniformly lined by urothelium over roof formed by tunica albuginea of the corpora cavernosa in successful cases. Failure cases showed diffuse fibrotic narrowing or circumferential scarring. Conclusion: Tunica albuginea is a locally available distensible tissue, sufficient to maintain the patency of the neourethra, without any graft or flap. TAU is easier and useful when patients have unhealthy oral mucosa due to tobacco chewing.

A retrospective analysis of delayed complications of urethroplasty at a tertiary care centre

“…These patients were subjected to different surgical techniques based on the data collected from the abovementioned investigations by taking into consideration the most appropriate procedure, considering the site of stricture as well as the degree of luminal narrowing and peri-urethral fibrosis, as obtained from these studies [3][4][5][6]. In case of any disagreement, the decision taken by RKM was considered final.…”

“…Success was gauged-based on our result assessment criteria, with good and fair results considered as successful (Table 1) [3][4][5][6].…”

“…The list of procedures included 95 tunica albuginea urethroplasty (as a tubularized segment) (TAU), 108 U-shaped prostato-bulbar anastomosis (USPBA), 40 dorsal buccal mucosa graft urethroplasty (DBMG), 28 skin substitution urethroplasty (SSU) and 31 dartos flap urethroplasty (skin dartos flap repair) (DFU). 12 patients with both anterior and posterior strictures were subjected to TAU and USPBA simultaneously [3][4][5][6].…”

Urethroplasty; Wide Range of Therapeutic Indications and Surgical Techniques

“…Barbagli et al [68] in their retrospective review of 350 patients undergoing oral mucosa harvest from a single check showed the majority of patients had no pain 85.2% or major complication. Mathur et al [69] described the successful use of the tunica albugina from the corpora for the urethroplasty with re-operation rate of 9.2% at 3 years in 206 patients . In 36 cases ranging between 10 and 20 cm in length, Xu et al [70] described success rates of 85.7% at a mean of 53.6 months using colonic mucosa .…”

Oral Mucosa Graft

“…The types of grafts used for urethral reconstruction include full thickness skin grafts, the split-thickness skin graft from the scrotum, penis and extra-genital sites, bladder epithelial grafts and oral mucosal grafts (Bhargava & Chapple, 2004;Weasells & McAninch, 1996 ). Other graft materials that have been used for substitution urethroplasty and include tunica vaginalis (Foinquinos et al, 2007), tunica albuginea (Mathur et al, 2009), colonic mucosa , small intestine submucosa (Donkov et al, 2006) and human dura matter (Maverich et al, 1998) The scrotal skin has been used for two-stage urethroplasty as it provides a large quantity of easily accessible graft but its keratinized epithelium and split-thickness depth increases susceptibility to post-operative contracture, hyperkeratosis leading to graft failure in the wet environment of the urethra and the increased risk of diverticulum formation . In addition, scrotal skin is usually hair -bearing and may form hair balls in the urethra.…”