ABSTRACT
OBJECTIVE@#To describe the technique and report the first transurethral buccal mucosal graft ventral inlay (Nikolavsky Technique) urethroplasty done in the Philippines, in a patient who had a fossa navicularis stricture extending to the distal penile urethra.@*METHODS@#Reported here is a case of a twenty-seven-year-old male who had a 40% distal urethral mucosal tear, as seen on initial cystoscopy, following traumatic catherization. The urethral tear was initially managed with a foley catheter maintained for a month. However, the patient eventually developed a 4 cm stricture extending from the fossa navicularis to the distal penile urethra. A ventral buccal mucosal graft was placed on the denuded urethral plate as an inlay patch via the transurethral route. No skin incisions nor penile degloving was done@*RESULTS@#Total operative time was four hours, including graft harvest time, with approximately 400 ml blood loss. The patient was sent home on the 3rd postoperative day. The urethral catheter was removed after 14 days. Post-operative follow-up was performed at 0-, 3- 6- and 12-months. A repeat voiding cystourethrogram was performed at 4 weeks showing no narrowing at the prior stricture site. On 12 months follow-up, uroflowmetry showed a Q-max of 20ml/sec with minimal residual urine. LUTS symptom scoring was at 7 and IIEF-5 score of 25@*CONCLUSION@#Repair of distal urethral strictures can be done using transurethral ventral buccal mucosa graft inlay urethroplasty. It can be challenging for longer strictures (>4 cm) but easily reproducible for shorter ones. The technique demonstrated good results on medium term follow-up. To the authors’ knowledge, this is the first reported case that utilized this technique in the Philippines.
ABSTRACT
INTRODUCTION@#Urethroplasty is the gold standard treatment for urethral stricture disease, regardless of the reconstructive technique utilized, because of its high success rate as compared with endoscopic urethrotomy or simple dilation. Among the different urethroplasty techniques, the Kulkarni Procedure has gained wide acceptance worldwide for strictures of varying etiologies. This is the first ever local experience study to review this one-sided dissection technique aimed at preserving the lateral blood and nervous supply to the urethra thereby increasing the chances of graft survival.@*METHODS@#A retrospective review from October 2017 – October 2021 was done. Twenty male patients were included. Their ages ranged from 24 to 75 years old (mean age 43). The patient underwent one-sided urethral dissection followed by dorsal onlay mucosal graft urethroplasty. All the surgeries were performed by a single surgeon. On follow up, outcomes were measured using a variety of tools. Incidence of postoperative complications and stricture recurrence were likewise noted.@*RESULTS@#In this study, 20 patients underwent one-sided dorsal onlay BMG (buccal mucosal graft) urethroplasty (Kulkarni technique), from October 2017 to October 2021.The outcome was deemed successful if the patient no longer needed additional procedures after the initial surgery. Of the 20 patients, 18 had successful outcomes. The other 2 patients had to undergo a redo urethroplasty.@*CONCLUSION@#This technique was shown to have an overall success rate of 92% in 24 patients, with a follow-up period of 12-55 months based on Kulkarni’s initial report in 2009. The results of the present study are similar wherein the overall success rate was 90% in 20 patients, but on a shorter follow up period. Despite the small sample size and short follow-up period, the results of the initial experience are very promising. As urologists gain more experience, they can achieve higher success rates in the future.