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
Objective To investigate the efficacy and safety of pedicled labium flap urethroplasty augmentation for female distal urethral stricture.Methods A retrospective review was performed involved 14 female distal urethral stricture patients from October 2014 to December 2016,with mean age of 59.5 years (range 47-77).There was one case secondary to trauma,5 cases secondary to iatrogenic injury,5 cases secondary to repeated urinary tract infection,and 3 cases with unknown etiology.The length of urethral stricture among the patients was 0.5 to 1.0 cm.The preoperative quality of life index was (4.6 ± 0.8),and the IPSS score was (20.7 ± 5.2),presenting severe lower urinary tract obstruction symptoms,with voiding symptom score of (13.6 ±3.9),and storage symptom score of(7.1 ± 1.7).The Qmax was (8.4 ±2.6)ml/s,and median residual urine volume was 88.5 ml(15-210 ml).All patients underwent dorsal onlay pedicled labium flap urethroplasty augmentation.Results The Qmax was (20.7 ± 3.5) ml,(19.5.± 3.9) ml and (18.8 ±2.7)ml at 1 month,6 months and 12 months follow-up,which were all superior to preoperative parameters,and the median residual urine volume was 23.0 ml(0-133 ml),21.5 ml (0-98 ml) and 26 ml (0-89 ml),which were significantly reduced.The quality of life index were (1.8 ± 0.8) and (2.1 ±0.9) after 6 months and 12 months of operation,which were better than preoperative scores.The IPSS score was (15.8 ± 2.8) and (15.7 ± 2.7),and the voiding symptom scores was (9.0 ± 2.1) and (8.9 ±2.0) after 6 months and 12 months of operation,which were all obviously reduced,while no significant change detected in storage symptom scores.At 12 months follow-up,there was no incontinence or recurrence.Condusions The application of dorsal onlay pedicled labium flap urethroplasty is a good option for female distal urethral stricture with the advantages of good safety,excellent effectiveness,few complications,less pain,and high satisfaction rate.
ABSTRACT
Objective To investigate the efficacy and safety of pedicled labium flap urethroplasty augmentation for female distal urethral stricture.Methods A retrospective review was performed involved 14 female distal urethral stricture patients from October 2014 to December 2016,with mean age of 59.5 years (range 47-77).There was one case secondary to trauma,5 cases secondary to iatrogenic injury,5 cases secondary to repeated urinary tract infection,and 3 cases with unknown etiology.The length of urethral stricture among the patients was 0.5 to 1.0 cm.The preoperative quality of life index was (4.6 ± 0.8),and the IPSS score was (20.7 ± 5.2),presenting severe lower urinary tract obstruction symptoms,with voiding symptom score of (13.6 ±3.9),and storage symptom score of(7.1 ± 1.7).The Qmax was (8.4 ±2.6)ml/s,and median residual urine volume was 88.5 ml(15-210 ml).All patients underwent dorsal onlay pedicled labium flap urethroplasty augmentation.Results The Qmax was (20.7 ± 3.5) ml,(19.5.± 3.9) ml and (18.8 ±2.7)ml at 1 month,6 months and 12 months follow-up,which were all superior to preoperative parameters,and the median residual urine volume was 23.0 ml(0-133 ml),21.5 ml (0-98 ml) and 26 ml (0-89 ml),which were significantly reduced.The quality of life index were (1.8 ± 0.8) and (2.1 ±0.9) after 6 months and 12 months of operation,which were better than preoperative scores.The IPSS score was (15.8 ± 2.8) and (15.7 ± 2.7),and the voiding symptom scores was (9.0 ± 2.1) and (8.9 ±2.0) after 6 months and 12 months of operation,which were all obviously reduced,while no significant change detected in storage symptom scores.At 12 months follow-up,there was no incontinence or recurrence.Condusions The application of dorsal onlay pedicled labium flap urethroplasty is a good option for female distal urethral stricture with the advantages of good safety,excellent effectiveness,few complications,less pain,and high satisfaction rate.