Advances in Clinical and Experimental Medicine
2015, vol. 24, nr 2, March-April, p. 297–300
Publication type: original article
Dorsal Onlay Buccal Mucosal Graft Urethroplasty in the Treatment of Urethral Strictures – Does the Stricture Length Affect Success?
1 Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Urology Clinic, Ankara, Turkey
2 Department of Urology, Faculty of Medicine, Bozok University, Yozgat, Turkey
3 Department of Urology, Karaman State Hospital, Karaman, Turkey
4 Department of Urology, Sivas Numune Hospital, Sivas, Turkey
Background. Treatment of urethral strictures can be challenging, but, with appropriate preoperative evaluation and surgical planning it is possible to achieve successful results.
Objectives. To analyze if the stricture length affects the success with dorsal onlay buccal mucosal graft urethroplasty technique.
Material and Methods. Between January 2004 and June 2010 a total of 40 patients with anterior urethral stricture were treated with dorsal onlay buccal mucosal graft urethroplasty. Age, etiology of the stricture, stricture length (≤ 7 cm, and > 7 cm), and localization of the stricture were assessed as the factors affecting success rate.
Results. The clinical outcome was defined as a failure when any operative instrumentation including dilatation was needed or the urine flow rate was less than 14 mL per second at the sixth month, postoperatively. The mean follow-up period was 43.44 months. Of 40 patients, 28 (70%) were successful and 12 (30%) were a failure. There was no statistically significant difference between the age groups, etiology of the stricture and success rate (p = 0.26 and p = 0.41). The statistical difference was significant for the localization and length of the stricture by means of success (p = 0.002 and p = 0.025).
Conclusion. Our results show that the stricture length and localization are the most important variables for desirable success. Even though surgical techniques are constantly evolving, long strictures stay as a problem for urologists. Studies with larger number of patients with long urethral strictures may support our findings, and may prove the efficiency of these surgical techniques.
buccal mucosa, urethral stricture, urethroplasty.
- MacDonald MF, Santucci RA: Review and treatment algorithm of open surgical techniques for management of urethral strictures. Urology 2005, 65, 9–15.
- Datta B, Rao MP, Acharya RL: Dorsal onlay buccal mucosal graft urethroplasty in long anterior urethral stricture. Int Braz J Urol 2007, 33, 181–186.
- Dubey D, Kumar A, Mandhani A, Srivastava A, Kapoor R, Bhandari M: Buccal mucosal urethroplasty: a versatile technique for all urethral segments. BJU Int 2005, 95, 625–629.
- Marchal C, Pérez JE, Herrera B: Barbagli’s dorsal urethroplasty. Analysis of results and factors for success. Arch Esp Urol 2010, 63, 537–544.
- Bhargava S, Chapple CR: Buccal mucosal urethroplasty: is it the new gold standard? BJU Int 2004, 93, 1191–1193.
- Humby G: A one-stage operation for hypospadias. Br J Surg 1941, 29, 84–92.
- Dubey D, Kumar A, Bansal P: Substitution urethroplasty for anterior urethral strictures: a critical appraisal of various techniques. BJU Int 2003, 91, 215–218.
- Bhandari M, Dubey D, Verma BS: Dorsal or ventral placement of the preputial/penile skin onlay flap for anterior urethral strictures: does it make a difference? BJU Int 2001, 88, 39–43.
- Heinke T, Gerharz EW, Bonfig R, Riedmiller H: Ventral onlay urethroplasty using buccal mucosa for complex stricture repair. Urology 2003, 61, 1004–1007.
- Barbagli G, Palminteri E, Rizzo M: Dorsal onlay graft urethroplasty using penile skin or buccal mucosa in adult bulbourethral strictures. J Urol 1998, 160, 1307–1309.
- Liu Y, Zhuang L, Ye W, Ping P, Wu M: One-stage dorsal inlay oral mucosa graft urethroplasty for anterior urethral stricture. BMC Urol 2014, 14, 35.
- El-Kassaby AW, El-Zayat TM, Azazy S, Osman T: One-stage repair of long bulbar urethral strictures using augmented Russell dorsal strip anastomosis: outcome of 234 cases. Eur Urol 2008, 53, 420–424.
- Barbagli G, Guazzoni G, Lazzeri M: One-stage bulbar urethroplasty: retrospective analysis of the results in 375 patients. Eur Urol 2008, 53, 828–833.
- Andrich DE, Dunglison N, Greenwell TJ, Mundy AR: The long-term results of urethroplasty. J Urol 2003, 170, 90–92.
- Barbagli G, Morgia G, Lazzeri M: Retrospective outcome analysis of one-stage penile urethroplasty using a flap or graft in a homogeneous series of patients. BJU Int 2008, 102, 853–860.
- Chen ML, Odom BD, Johnson LJ, Santucci RA: Combining ventral buccal mucosal graft onlay and dorsal full thickness skin graft inlay decreases failure rates in long bulbar strictures (≥ 6 cm). Urology 2013, 81, 899–902.
- Barbagli G, Palminteri E, Lazzeri M, Guazzoni G, Turini D: Long-term outcome of urethroplasty after failed urethrotomy versus primary repair. J Urol 2001, 165, 1918–1919.