Urethroplasty for High Risk, Long Segment Urethral Strictures with Ventral Buccal Mucosa Graft and Gracilis Muscle Flap

Palmer, Drew; Buckley, Jill C.; Zinman, Leonard; Vanni, Alex J.

doi:10.1016/j.juro.2014.09.093

Cited by 43 publications

(20 citation statements)

References 11 publications

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“…recently reported using a modified ventral onlay urethroplasty with buccal mucosa and a gracilis muscle flap as a graft bed in 20 patients with highly complicated urethral strictures deemed not amenable to conventional onlay augmentation procedures and urethroplasty. For 16 patients (80%), the procedure was successful and urinary diversion was not required …”

Section: Categorization Of Substitution Urethroplasty Using Oral Mucomentioning

confidence: 99%

Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews

Horiguchi

2017

Int J of Urology

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Male anterior urethral stricture is scarring of the subepithelial tissue of the corpus spongiosum that constricts the urethral lumen, decreasing the urinary stream. Its surgical management is a challenging problem, and has changed dramatically in the past several decades. Open surgical repair using grafts or flaps, called substitution urethroplasty, has become the gold standard procedure for anterior urethral strictures that are not amenable to excision and primary anastomosis. Oral mucosa harvested from the inner cheek (buccal mucosa) is an ideal material, and is most commonly used for substitution urethroplasty, and lingual mucosa harvested from the underside of the tongue has recently emerged as an alternative material with equivalent outcome. Onlay augmentation of oral mucosa graft on the ventral side (ventral onlay) or dorsal side (dorsal onlay, Barbagli procedure) has been widely used for bulbar urethral stricture with comparable success rates. In bulbar urethral strictures containing obliterative or nearly obliterative segments, either a two-sided dorsal plus ventral onlay (Palminteri technique) or a combination of excision and primary anastomosis and onlay augmentation (augmented anastomotic urethroplasty) are the procedures of choice. Most penile urethral strictures can be repaired in a one-stage procedure either by dorsal inlay with ventral sagittal urethrotomy (Asopa technique) or dorsolateral onlay with one-sided urethral dissection (Kulkarni technique); however, staged urethroplasty remains the procedure of choice for complex strictures, including strictures associated with genital lichen sclerosus or failed hypospadias. This article presents an overview of substitution urethroplasty using oral mucosa graft, and reviews current topics.

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Section: Categorization Of Substitution Urethroplasty Using Oral Mucomentioning

confidence: 99%

Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews

Horiguchi

2017

Int J of Urology

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“…EPA performed in 183 patients had a 70–97% success rate within 3–4 years (70,72,75,76). BMG with or without gracilis muscle flap was done in 70 patients and had a success rate of 71–80% within 2–4 years (70,73,74,76). Flap urethroplasty was performed in 10 patients and had a success rate that varied between 50–100% within 2–4 years (70,71,76).…”

Section: Managementmentioning

confidence: 99%

Management of bladder neck stenosis and urethral stricture and stenosis following treatment for prostate cancer

Nicholson

Al-Hakeem

Maldonado

et al. 2017

Transl. Androl. Urol.

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The aim of this review is to examine all urethral strictures and stenoses subsequent to treatment for prostate cancer, including radical prostatectomy (RP), radiotherapy, high intensity focused ultrasound (HIFU) and cryotherapy. The overall majority respond to endoscopic treatment, including dilatation, direct visual internal urethrotomy (DVIU) or bladder neck incision (BNI). There are adjunct treatments to endoscopic management, including injections of corticosteroids and mitomycin C (MMC) and urethral stents, which remain controversial and are not currently mainstay of treatment. Recalcitrant strictures are most commonly managed with urethroplasty, while recalcitrant stenosis is relatively rare yet almost always associated with bothersome urinary incontinence, requiring bladder neck reconstruction and subsequent artificial urinary sphincter (AUS) implantation, or urinary diversion for the devastated outlet.

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“…However, all patients described in this article have limited preputial tissue. Although technique selection is admittedly based on surgeon preference and experience, staged buccal mucosa graft urethroplasty has recently gained popularity following favorable reports in the literature [6,7,8]. Staged buccal mucosa free grafting urethroplasty appears to be a suitable technique for salvage urethroplasty in these patients with prior failed hypospadias repair [5].…”

Section: Discussionmentioning

confidence: 99%

Scrotal-Septal Fasciocutaneous Flap Used as a Multifunctional Coverage for Prior Failed Hypospadias Repair

Zhang¹,

Zhou²,

Li³

et al. 2016

Urol Int

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Objectives: The study aims to report the method and outcome of using scrotal-septal fasciocutaneous flap as a multifunctional coverage for prior failed hypospadias repair. Methods: From January 2014 to June 2015, 18 hypospadias patients who have undergone repeated failed surgeries were enrolled. Their penile skin, urethral plate and dartos fascia are not enough to reconstruct the urethra, but have well-developed scrota. We performed urethroplasty by buccal mucosa free grafting and tubularized anastomosis 6 months after the urethroplasty. Then, scrotal-septal fasciocutaneous flap was used to be a multifunctional coverage on the surface of anastomotic urethra, which was a waterproof layer and cutaneous coverage. Results: The skin flaps survived and the incisions healed in 18 patients. No fistula and stricture occurred. The scar of donor site seemed like a new scrotal raphe. The flap can slip slightly along with the preputial movement and retain the original sense of touch. All patients were followed up at 1 and 6 months by telephone or in person and gained good recoveries. Conclusion: Scrotal-septal fasciocutaneous flap, including sufficient fascia tissue, reliable blood supply and skin coverage, is a good choice for the coverage of anastomotic urethra as both the waterproof layer and skin coverage, especially for hypospadias patients who have undergone several failed operations.

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Urethroplasty for High Risk, Long Segment Urethral Strictures with Ventral Buccal Mucosa Graft and Gracilis Muscle Flap

Abstract: Urethroplasty for high risk, long segment urethral strictures can be successfully performed with a ventral buccal mucosa graft and a gracilis muscle flap, avoiding urinary diversion in most patients.

Cited by 43 publications

References 11 publications

Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews

Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews

Management of bladder neck stenosis and urethral stricture and stenosis following treatment for prostate cancer

Scrotal-Septal Fasciocutaneous Flap Used as a Multifunctional Coverage for Prior Failed Hypospadias Repair

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