ABSTRACT
The potentials for the use of free buccal mucosa graft in reconstruction plastic surgery of extended uretral stricture are evaluated. From 2007 to 2013, 9 operations in 8 patients (mean age 54,5+/-7,2 years) were performed. The average length of cicatricial uretral stricture was 5,1+/-0,7 cm. 1 patient has lesion in the upper third of the ureter, 4 patients - in the middle portion, and 4 patients - at the bottom portion. The causes of extended uretral stricture were following: long standing calculi (n=3), ureteral injury after ureterolithotripsy (n=2) and after bringing down the calcuus using loop (n=1), radiotherapy (n=3, one patient had bilateral injury). All patients underwent plastic reconstruction of ureter using buccal mucosa graft by "on-lay" type. During the follow-up (median, 42 months, from 3 to 72 months), in 7 (88,9 %) of 8 patients (8 operations) ureteral strictures relapses were not observed. They all had satisfactory renal excretory function without the pronounced violations of passage of urine along the ureter. The excretory urography showed moderate expansion of the ureter at the site of operation in 6 of them. Due to the progression of secondary renal scarring, one patient underwent nephrectomy 1.5 year after reconstruction plastic surgery. In this patient, pronounced anatomical and functional changes in the kidney occurred before the operation. Application of the buccal mucosa graft in reconstruction plastic surgery in extended uretral stricture is high effective due to the relatively low level of early and late postoperative complications and low recurrence rate.
Subject(s)
Mouth Mucosa/surgery , Plastic Surgery Procedures/methods , Ureteral Calculi/surgery , Urologic Surgical Procedures/methods , Adult , Aged , Female , Humans , Male , Middle Aged , Mouth Mucosa/pathology , Ureteral Calculi/pathologyABSTRACT
The study included 18 patients with recurrent strictures of the anterior urethra. In 16 patients the recurrence arose after several endoscopic operations for inflammatory urethral strictures, in 2--after plastic repair of the stricture by loganson and plastic treatment of hypospadia. The strictures varied in length from 3 to 16 cm. Ventral flap of buccal mucosa was used for plastic reconstruction in 16 patients, dorsal flap--in 2 patients. Follow-up lasted from 1 to 15 months. All the patients were cured. The intubation drainage was removed 4-7 weeks after the operation. Qmax elevated, on the average, from 4.79 +/- 0.78 to 29.5 +/- 1.94 ml/s. The recurrence developed only in 1 patient 6 months after the plastic repair. The patient was successfully operated (internal optic urethrotomy). Thus, short-term outcomes of urethroplasty with buccal transplant showed this operation to be highly effective in correction of long recurrent strictures of anterior urethra in males.
