Bulbar substitution urethroplasty by use of tubularized ventral and dorsal onlay buccal mucosal grafts

ABSTRACT

We report our experience and evaluation of the outcome in men undergoing bulbar urethral reconstruction with tubulanzed neourethra from ventrally and dorsally situated buccal mucosal onlay grafts. Twelve patients with urethral stricture underwent substitution bulbar urethroplasty with buccal mucosal grafts. Preoperative evaluation was performed with complete urine analysis with culture and sensitivity tests, uroflow, retrograde and voiding cystourethrogram and urethral sonography. Complete excision of the stricture area was performed with preservation of the healthy corpus spongiosum intact as a separate vascular layer. Harvesting of 2 buccal mucosal grafts was done from cheek. The 1[st] graft was fixed dorsally onto the corporeal bodies. The 2[nd] graft was fixed ventrally to the undersurface of corpus spongiosum. Fashioning of the grafts was performed as a tube over a 14 Fr catheter. Three months after catheter removal; urinary flow rate, AUA symptom scores and retrograde urethrogram were performed. The average age of our patients was 33.5 years. Average follow up was 12 months. Of strictures, 2 patients [16.7%] were idiopathic in origin, 4 [33.3%] were traumatic, 4 [33.3%] were infectious and 2 [16.7%] were iatrogemc. The average stricture length was 3 cms. The average operative time was 165 mm. The average estimated blood loss was 214 ml. Hospital stay averaged 3.2 days. Peak unnary flow rates improved from an average of 7.9ml/second to 30.4 ml/second [p < 0.001]. AUA symptom scores decreased from an average of 20.5 preoperatively to 43 postoperatively [p < 0.001]. There were 2 early postoperative complications, 1 had a postoperative febrile UTIs and another patient had prolonged penurethral leakage which heal spontaneously. The overall success rate was 91.7%. Three to 6 months after surgery, RGUG demonstrated small non symptomatic ventral sacculation in one patient and narrowing in another patient which required endoscopic incision. The creation of neourethra from modulation of ventrally and dorsally situated onlay buccal mucosal grafts after complete excision of strictured urethra is a new added reasonable and reconstructive option for management of long bulbar urethral strictures [>2cm.]. However, more efforts, researches and extended follow up are necessary to establish and explain the hidden secretes of improving the outcome of substitution urethroplasty with buccal mucosal grafts