Dorsal onlay buccal mucosal graft urethroplasty in inflammatory stricture of urethra – Our experience

Urethral stricture is a common disease with changing etiology and changing practices in management. Management options were grossly determined by cause, site, length of stricture and also by other factors like prior attempts of repair and local genital skin condition. Treatment options vary from dilatation, optical urethrotomy to various types of urethroplasty. Substitution urtethroplasty is done using various types of graft materials like skin, buccal mucosa, bladder mucosa or colonic mucosa. Over the past 10-15 years buccal mucosa grafts have been increasingly used in the urethral reconstruction. Barbagli technique (Dorsal onlay technique) has the advantages of no sacculation which is seen with ventral onlay grafts, good neovascularity and less shrinkage (10%) rate. We have presented the results and complications of doral onlay buccal mucosa graft urethroplasty (Barbagli technique) in 20 cases performed over a period of 30 months in our institution. Our study showed a success rate of 80% at the end of 2yrs follow up, comparable with other studies, with a restructure rate of 20%. None of our patients developed urethrocutaneous fistula and urethral diverticulum.

Our experience with ileocystoplasty for augmentation of tuberculous bladders

Augmentation cystoplasty has traditionally been used in the treatment of low capacity, poorly compliant or contracted bladders. Various bowel segments can be used for augmentation with its own advantages and disadvantages like ileum, sigmoid, cecum, ileo cecal, stomach etc. The surgical technique involves detubularisation and reconfiguration of bowel to create a patch. A successful clinical outcome depends on creating a large capacity, low pressure reservoir to store urine. Present study was retrospective study conducted from November 2010 to March 2014 on 7 patients (5 men, 2 women with mean age 32 years). Early complications: wound infection in 3 cases, wound dehiscence in 2 cases, urinary leakage in 1 case. Late complications: recurrent UTI in 2 cases, increased mucus production in one case, bladder stone formation in one case. All were grade I to III according to Clavien- Dindo classification. No major (grade IV or V) complications. As in our experience ileocystoplasty for augmentation of tuberculous bladder is a safe and effective procedure.