Ventral onlay buccal mucosa urethroplasty: A 10‐year experience

Abstract

Objective: To report our experience, and to evaluate the long-term outcomes and complication profiles of ventral onlay buccal mucosal graft urethroplasty (BMU) after prior urological intervention. Methods: We retrospectively reviewed 114 consecutive patients between February 2001 and April 2009 who underwent buccal mucosal graft urethroplasty for recurrent anterior urethral stricture disease. Seven patients were excluded for incomplete data. The remaining 107 patients comprised the study cohort. The mean follow-up time was 39.3 months (range 6.6-127.3 months). All patients had prior urological attempts at operative management. Results: The mean stricture length was 3.14 cm (range 1.0-8.0 cm). Indications for buccal mucosal graft urethroplasty included: lichen sclerosis (2.8%), iatrogenic (24.3%), infection (4.7%) and perineal trauma/straddle injury (20.6%). Of these patients, 78 had bulbomembranous stricture disease, 20 had penile involvement and nine were multifocal strictures. The average number of prior urological procedures was 2.83 (range 1-9). The overall graft failure rate was 6.5%. Importantly, the re-operation rate was 20.6%, primarily for stricture recurrence (18), meatal stenosis (3) and urethral diverticulum. The mean time to complication was 10.8 months. Conclusions: Ventral onlay buccal mucosal graft urethroplasty offers satisfactory results in the setting of recurrent and complicated urethral stricture disease. Graft failures and complications generally occur within the first year after surgery. Bulbar strictures enjoy greater graft patency and lower complication rates than other stricture locations. In particular, guarded expectations should be given for stricture length >4 cm and multifocal disease.

Long term outcomes of one-stage augmentation anterior urethroplasty: a systematic review and meta-analysis

“…This analysis suggests a progressive deterioration rate over time for AU, which has been observed in multiple urethroplasty series (9,10,14,31,32). Several series have indicated that most failures occur within the first two years following urethroplasty; however, not all urethroplasty failures are equivalent (10,14,31). There are several potential explanations for AU failure; under-estimation of stricture length or degree of spongiofibrosis, failure of the graft to take due to poor host bed conditions, or flap loss due to compromised pedicle.…”

Acellular Bi-Layer Silk Fibroin Scaffolds Support Tissue Regeneration in a Rabbit Model of Onlay Urethroplasty

“…In circumstances in which there is a lack of patient urethral tissue, extragenital skin flaps [9] , [10] , buccal mucosa [11] , bladder mucosa [12] , [13] , and tunica vaginalis [14] have been utilized clinically as autologous tissue grafts for urethroplasty procedures. In addition to the risk of donor site morbidity, the long-term success of these implants is often suboptimal due to significant complications such as fistula formation [15] , recurrent strictures [16] , hair growth [17] , stone formation [18] , diverticula [19] , and meatal stenosis [20] . Given the limitations associated with conventional surgical approaches, there exists a substantial need for the development of alternative strategies for urethral tissue replacement.…”

Pediatric Bulbar and Posterior Urethral Injuries: Operative Outcomes and Long-Term Follow-Up

“…Several techniques are described in the literature how to achieve tension free end-to-end anastomosis of injured posterior and bulbar urethra. There is a group of substitution techniques using skin flap, 5 ventral or inlay buccal mucosa free graft, 4,6 or more rarely appendix, ileum, 7 or colon mucosa. 8 The second group of techniques describes urethral rerouting, perineal, perineal-abdominal, or trans pubic techniques to achieve tension free anastomosis.…”

“…Finally, our hesitancy to use buccal mucosa graft for longer strictures as it described in adults as well as in children might have changed the results. 6 Voelzke et al 4 describes the use of buccal mucosa graft in selected patients with obstructed but not obliterated lumen to prevent penile shortening.…”