1
|
Singh RP, Jamal A. Circular Penile Skin Fasciocutaneous Ventral Onlay Flap Urethroplasty as an Alternative to Dorsal Onlay Buccal Mucosal Graft Urethroplasty in Complex Long-Segment Urethral Stricture: A Retrospective Study. Cureus 2023; 15:e45084. [PMID: 37842454 PMCID: PMC10568655 DOI: 10.7759/cureus.45084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Background A urethral stricture is the narrowing of the urethra that results in symptoms of obstruction. It can appear anywhere along the male urethra's length and has a variety of causes. The circular penile fasciocutaneous flap is employed in the successful single-stage reconstruction of long-segment complex anterior urethral strictures especially when the buccal mucosa is unavailable due to various reasons. The study has tried to identify a surgical technique that is more beneficial for the treatment of urethral strictures. Objective The objective of this research was to evaluate the outcomes of circular penile skin fasciocutaneous ventral onlay flap urethroplasty (group A) and the outcomes of dorsal onlay buccal mucosal graft urethroplasty (group B) in the management of complex long-segment penile urethral stricture. Methods In this retrospective study between December 2012 and December 2022, 60 patients with long-segment complex penile urethral stricture who underwent urethroplasty at our center were evaluated. Patients were divided into two groups according to the flap used (dorsal onlay buccal mucosal graft urethroplasty was used in 30 patients (group B), and circular penile fasciocutaneous flap (single stage) was used in 30 patients (group A)). The success rate and the mean peak flow rate were also calculated post-operation to identify the effectiveness of the surgical procedure used for urethral strictures. Results The study consisted of 60 patients in total. Group A's mean age was determined to be 51.2±16.2 years, whereas group B's mean age was determined to be 40.7±16.8 years. Preoperatively, the median urethral stricture length was 69 mm in group A (range: 20-100 mm) and 56 mm in group B (range: 30-110 mm). The intraoperative median length of the urethral stricture was 82 mm in group A (range: 20-120 mm) and 65 mm in group B (range: 40-140 mm). The mean peak flow rate was 30.9±6.8 mL/s in group A compared to 18.1±4.9 mL/s in group B. The success rate for group A was 89.7%, while the success rate for group B was 75.9%. Conclusion For complex long-segment urethral strictures, circular penile skin fasciocutaneous ventral onlay flap urethroplasty has a higher rate of success and fewer complications than dorsal onlay buccal mucosal graft urethroplasty. Along with success rate, it has a better mean peak flow rate and lower complications.
Collapse
Affiliation(s)
- Rana P Singh
- Department of Urology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Arshad Jamal
- Department of Urology, Rajendra Institute of Medical Sciences, Ranchi, IND
| |
Collapse
|
2
|
Guan H, Sholklapper T, Crigger C, Haney N, Harris TGW, Gearhart JP. The use of a modified tanagho flap in the repair of posterior urethral stricture after primary exstrophy closure. J Pediatr Urol 2023; 19:37.e1-37.e7. [PMID: 36369236 DOI: 10.1016/j.jpurol.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/03/2022] [Accepted: 10/08/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION In patients with classic bladder exstrophy (CBE), posterior urethral strictures after primary bladder closure can be difficult to manage and therefore necessitate alternative techniques in reconstruction of the proximal urethra. There is a paucity of literature describing treatment and management of posterior urethral stricture arising after repair of classic bladder exstrophy. OBJECTIVE To describe the technique of a bladder neck reconstruction (BNR) with a modified Tanagho anterior detrusor flap in the treatment of posterior urethral stricture arising after repair of classic bladder exstrophy. PATIENTS AND METHODS A prospectively maintained, IRB-approved database of 1401 exstrophy-epispadias patients was reviewed for patients who underwent bladder neck or proximal urethral reconstruction with modified Tanagho flap for proximal urethral stricture disease from the time period of 1975-2021. A total of 5 patients (1 female and 4 males) with classic bladder exstrophy who underwent proximal urethral reconstruction with modified Tanagho flap were identified. Of these 5 patients, the 1 female patient was treated for ongoing incontinence, not posterior urethral stricture, and was thus excluded from this report. Outcomes measured included post operative bladder capacity, post-operative continence status, upper urinary tract status, and stricture recurrence. RESULTS Four male patients with CBE were treated for posterior urethral strictures and are reviewed here. Three patients underwent successful primary closure (1 via modern staged repair of exstrophy (MSRE) and 2 via complete primary repair of exstrophy (CPRE)), and 1 patient (MSRE) required repeat closure at the time of stricture repair. Mean age at BNR Tanagho flap was 3.8 (range 2.3-5.0) years. All patients remained stricture free with post-operative urinary incontinence; 2 patients underwent subsequent elective bladder neck transection to achieve continence. Mean follow up 9.9 (range 2.1-15.6) years. DISCUSSION All 4 patients had excellent long term success rates, comparable to results reported in several adult studies utilizing a modified Tanagho flap in women with post-traumatic bladder neck contractures. In addition, our technique described here shares similarities with both the originally described Tanagho flap as well as with a dorsal onlay graft urethroplasty. CONCLUSION In this limited series, modified Tanagho flap reconstruction is effective in treating posterior urethral stricture disease in CBE. This technique adds a valuable adjunct to the armamentarium of surgical options for this difficult to manage condition.
Collapse
Affiliation(s)
- Hannah Guan
- Brady Urological Institute, Johns Hopkins Medicine; Baltimore, MD, USA; Department of Urology, University of Maryland, MD, USA
| | - Tamir Sholklapper
- Brady Urological Institute, Johns Hopkins Medicine; Baltimore, MD, USA
| | - Chad Crigger
- Brady Urological Institute, Johns Hopkins Medicine; Baltimore, MD, USA
| | - Nora Haney
- Brady Urological Institute, Johns Hopkins Medicine; Baltimore, MD, USA
| | - Thomas G W Harris
- Plastic and Reconstructive Surgery, Johns Hopkins Medicine; Baltimore, MD, USA
| | - John P Gearhart
- Brady Urological Institute, Johns Hopkins Medicine; Baltimore, MD, USA.
| |
Collapse
|
3
|
Halbe L, Ergashev B, Heidenreich A, Karapanos L. Bilateral T-shaped Scrotoplasty as an Ancillary Technique of Staged Anterior Urethroplasty: The End Justifies the Means. Cureus 2022; 14:e27810. [PMID: 36106306 PMCID: PMC9452050 DOI: 10.7759/cureus.27810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
Staged urethroplasty is performed to treat long-segment obliterating anterior urethral strictures. The technique is particularly challenging when the penobulbar junction is involved, as it requires the transection of the scrotum and the formation of lateral testicular fans. To date, there is no established surgical protocol for this ancillary technique in large volume scrotums with excess skin. We report a case of staged urethroplasty with the necessity of performing T-scrotoplasty due to bulky scrotum. After six months, the T-plasty was successfully resolved, and a new scrotum was formed from the two hemiscrota. In conclusion, scrotoplasty using a bilateral T-plasty is an excellent technique to overcome the necessity of splitting the scrotum by externalizing the urethra to allow for excellent buccal mucosal graft healing over a period of six months. The two separate testicular fans can be reapproximated along the raphe after re-tubularizing the urethra in the 2nd stage, shaping a new scrotum with satisfactory cosmetic results.
Collapse
|
4
|
El-Kassaby AW, Saber Khalaf M, Reyad AM. Management of men with ultra-short penile urethral stricture using augmented anastomotic penile skin flap urethroplasty; a retrospective analysis. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The management of short anterior urethral stricture is challenging. Our study aims to evaluate the outcome of augmented anastomotic urethroplasty (AAU) for the management of men with ultra-short penile urethral stricture, and to compare it with the dorsal onlay buccal mucosa graft.
Methods
Databases of two tertiary referral centres were retrospectively reviewed to retrieve data of men with ultra-short penile urethral stricture who underwent urethroplasty from 2013 to 2020. Patients who underwent AAU with ventral onlay pedicled skin flap were considered the study group, while patients treated with the dorsal onlay graft augmentation were included as controls. Surgical outcomes included urethral patency, improvement in the maximum flow rate (Qmax), change in sexual satisfaction, and any reported complications.
Results
Thirty-four patients (and 30 controls) with a median age of 26–27 years were included in the study. The maximum flow rate improved significantly in both groups compared to the preoperative value (p < 0.001). The success rate was 88% in the study group compared to 76.7% in the control group. There was no statistically significant difference in the frequency of postoperative penile curvature nor the ventral sacculation between the two groups (p = 0.788 and 0.913). The operative time was statistically significantly longer in the control group (p = 0.044), while the frequency of postoperative void dripping was much higher in the study group (p = 0.007).
Conclusion
The success rate and complications of AAU for men with ultra-short penile urethral stricture were comparable to the dorsal buccal graft.
Collapse
|
5
|
Patil N, Javali T. Paediatric Buccal Mucosal Graft Urethroplasty for Non-Hypospadias Urethral Strictures: A Single Centre Experience with Long Term Outcomes. Urology 2021; 158:174-179. [PMID: 34274391 DOI: 10.1016/j.urology.2021.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To review our experience in the management of paediatric urethral strictures with buccal mucosal graft urethroplasty and its long term outcomes. METHODS This was a retrospective analysis of a prospectively maintained data base between 2009-2019. Circumcised children with long segment urethral strictures (> 1.5 cm) were included. They were characterized as either peno-bulbar (PBS) or isolated bulbar strictures (IBS) based on a standardized protocol. All children underwent single stage dorsal onlay buccal mucosal graft urethroplasty by either the Kulkarni technique (PBS group) or the Barbagli technique (IBS group). All children were followed up at 3 months, then annually thereafter with flow rates at each visit. Success was defined as a flow rate > 10ml/sec with a bell-shaped curve and absence of need for any secondary procedures. RESULTS 28 children underwent buccal mucosal graft uretheroplasty.16 children were diagnosed with PBS & 12 children with IBS. The median age was 7.5 years (2-17 years) in PBS and 5.5 years (3-10 years) in IBS. Iatrogenic injury was the commonest aetiology ie 71 % (20/28). Mean length of stricture was 4 cm (3-5.5 cm) in PBS and 2.5 cm (2-3.5 cm) in IBS. Median follow up was 96 months (24-120 months) in PBS and 90 months (36-120 months) in IBS. The success rate was 87.5% (14/16) in PBS and 83.3% (10/12) in IBS. CONCLUSION Single stage dorsal on lay buccal mucosal graft urethroplasty, ie Kulkarni and Barbagli techniques are safe and feasible in children with long segment urethral strictures with good long-term outcomes.
Collapse
Affiliation(s)
- Neehar Patil
- Department of Paediatric Surgery and Urology, Ramaiah Medical College and Hospital, Bangalore, India.
| | - Tarun Javali
- Department of Urology, Ramaiah Medical College and Hospital, Bangalore, India.
| |
Collapse
|
6
|
Barroso U, Prado F. A new double graft technique in urethroplasty for complex urethral stenosis: preliminary findings. Int Braz J Urol 2021; 47:856-860. [PMID: 33848080 PMCID: PMC8321498 DOI: 10.1590/s1677-5538.ibju.2020.1131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 01/29/2023] Open
Abstract
The management of complex urethral stenosis may involve different surgical techniques. As retraction of the graft may account for surgical failure, this risk increases in patients with more extensive stenosis requiring a graft of greater diameter. Although double grafts have already been used to maximize success in these cases, we propose a modified technique for urethroplasty with longitudinal urethral incision. The hypothesis was that this technique would increase the lumen by using only a urethral incision on the dorsal surface. Two patients presenting with recurrent urethral stenosis underwent urethroplasty using a double graft of oral mucosa that preserves the integrity of the spongy tissue and allows ventral inlay graft fixation using a midline relaxing incision in the portion of the urethra with stenosis. In both cases, the urethrocystoscopy and uroflowmetry performed after surgery showed a pervious and complacent urethra. After four and six months of follow-up, the postoperative outcomes were satisfactory for both patients. Further studies involving larger numbers of patients and long-term follow-up are required to evaluate the effectiveness of this method.
Collapse
Affiliation(s)
- Ubirajara Barroso
- Clínica de Distúrbios do Trato Urinário, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brasil
| | - Filip Prado
- Clínica de Distúrbios do Trato Urinário, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brasil
| |
Collapse
|
7
|
Barratt R, Chan G, La Rocca R, Dimitropoulos K, Martins FE, Campos-Juanatey F, Greenwell TJ, Waterloos M, Riechardt S, Osman NI, Yuan Y, Esperto F, Ploumidis A, Lumen N. Free Graft Augmentation Urethroplasty for Bulbar Urethral Strictures: Which Technique Is Best? A Systematic Review. Eur Urol 2021; 80:57-68. [PMID: 33875306 DOI: 10.1016/j.eururo.2021.03.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/24/2021] [Indexed: 01/17/2023]
Abstract
CONTEXT Four techniques for graft placement in one-stage bulbar urethroplasty have been reported: dorsal onlay (DO), ventral onlay (VO), dorsolateral onlay (DLO), and dorsal inlay (DI). There is currently no systematic review in the literature comparing these techniques. OBJECTIVE To assess if stricture recurrence and secondary outcomes vary between the four techniques and to assess if one technique is superior to any other. EVIDENCE ACQUISITION The EMBASE, MEDLINE, and Cochrane Systematic Reviews-Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane HTA, DARE, HEED) databases and ClinicalTrials.gov were searched for publications in English from 1996 onwards. Randomised controlled trials (RCTs), nonrandomised comparative studies (NRCSs), observational studies (cohort, case-control/comparative, single-arm), and case series with ≥20 adult male participants were included. EVIDENCE SYNTHESIS A total of 41 studies were included involving 3683 patients from one RCT, four NRCSs, and 36 case series. Owing to the overall low quality of the evidence, a narrative synthesis was performed. CONCLUSIONS No single technique appears to be superior to another for bulbar free graft urethroplasty. Both DO and VO are suitable for bulbar augmentation urethroplasty, with a ≤20% recurrence rate over medium-term follow-up. No recommendations can be made regarding DI or DLO techniques owing to the paucity of evidence. Secondary outcomes including sexual function, and complications are infrequently reported. Recurrence rates deteriorate in the long term for both DO and VO procedures. PATIENT SUMMARY We reviewed the evidence for four different skin-graft techniques used to repair narrowing of a section of the urethra (bulbar urethra, under the scrotum and perineum) in men. Two of the techniques seem to give consistent results, with recurrence rates lower than 20%. Recurrence rates increase over time, so patients should continue to monitor their symptoms. There is poorer reporting of other outcomes such as sexual function, urinary symptoms, and complications, and it is possible that these occur more frequently than the current data suggest.
Collapse
Affiliation(s)
- Rachel Barratt
- Department of Urology, University College London Hospital, London, UK.
| | - Garson Chan
- Division of Urology, University of Saskatchewan, Saskatoon, Canada
| | - Roberto La Rocca
- Department of Urology, University of Naples Federico II, Naples, Italy
| | | | - Francisco E Martins
- Department of Urology, Santa Maria University Hospital, University of Lisbon, Lisbon, Portugal
| | | | | | | | - Silke Riechardt
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nadir I Osman
- Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Yuhong Yuan
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada
| | | | | | - Nicolaas Lumen
- Division of Urology, Gent University Hospital, Gent, Belgium
| | | |
Collapse
|
8
|
Galgano SJ, Sivils C, Selph JP, Sanyal R, Lockhart ME, Zarzour JG. The Male Urethra: Imaging and Surgical Approach for Common Pathologies. Curr Probl Diagn Radiol 2020; 50:410-418. [PMID: 32682681 DOI: 10.1067/j.cpradiol.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/12/2020] [Accepted: 06/22/2020] [Indexed: 11/22/2022]
Abstract
Urethral pathology is common in clinical practice and important to recognize. It is essential to recognize urethral pathology on imaging and to understand how to best image the urethra. In this way, the radiologist can provide the urologist with the necessary information prior to intervention. Basic knowledge of commonly performed urethral surgeries can help the radiologist understand the expected appearance of the post-treatment urethra and common postoperative complications.
Collapse
Affiliation(s)
- Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL.; O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL..
| | - Corey Sivils
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - J Patrick Selph
- O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL.; Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - Rupan Sanyal
- Department of Radiology, Mayo Clinic, Jacksonville, FL
| | - Mark E Lockhart
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Jessica G Zarzour
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
9
|
Manasherova D, Kozyrev G, Nikolaev V, Abdullaev F, Abdulkarimov G, Kushnir B, Gazimiev M. Bracka's Method of Proximal Hypospadias Repair: Preputial Skin or Buccal Mucosa? Urology 2019; 138:138-143. [PMID: 31901472 DOI: 10.1016/j.urology.2019.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze treatment results of staged surgical repair of proximal forms of hypospadias according to Bracka's technique using preputial vs buccal grafts. MATERIAL AND METHODS We retrospectively reviewed 220 patients with proximal forms of hypospadias treated with Bracka's urethroplasty technique. They were divided into 2 groups: Group I-108 patients treated with preputial skin grafts in 2001-2013; Group II-112 patients who underwent urethroplasty with buccal mucosa grafts in 2013-2016. RESULTS AND DISCUSSION Of the Group I patients with preputial skin grafts, complications were obtained in 33 (31%) cases; in Group II-23 (20%) cases. Complications include fistulas, defects of urethra, and scar contraction of grafts. The cosmetic results according to Hypospadias Objective Penile Evaluation scale were more satisfactory when buccal mucosa grafts were used. Further studies are needed to analyze the long-term changes posturethroplasty with both preputial skin and buccal mucosa grafts. CONCLUSION This is one of the only studies to compare complications and histology of the 2 free grafts: preputial skin and buccal mucosa. This study affirms that a staged surgical method with the use of free grafts according to Bracka's technique is a successful method of treatment of proximal forms of hypospadias in children achieving good functional and cosmetic results with a relatively low rate of complications.
Collapse
Affiliation(s)
- Dina Manasherova
- Moscow State University, Faculty of Fundamental Medicine, Moscow, Russia.
| | - German Kozyrev
- Uroandrology Department of the Russian Children's Clinical Hospital of the Russian Ministry of Health, Moscow, Russia.
| | - Vasily Nikolaev
- Uroandrology Department of the Russian Children's Clinical Hospital of the Russian Ministry of Health, Moscow, Russia
| | - Fuad Abdullaev
- Uroandrology Department of the Russian Children's Clinical Hospital of the Russian Ministry of Health, Moscow, Russia
| | - Gamzat Abdulkarimov
- Uroandrology Department of the Russian Children's Clinical Hospital of the Russian Ministry of Health, Moscow, Russia
| | - Berta Kushnir
- Department of Anatomical Pathology of the Russian Children's Clinical Hospital of the Russian Ministry of Health, Moscow, Russia
| | - Magomed Gazimiev
- Urology Department of Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
10
|
Single-stage buccal mucosal graft urethroplasty for meatal stenoses and fossa navicularis strictures: a monocentric outcome analysis and literature review on alternative treatment options. World J Urol 2019; 38:2609-2620. [DOI: 10.1007/s00345-019-03035-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022] Open
|
11
|
Zumstein V, Dahlem R, Kluth LA, Rosenbaum CM, Maurer V, Bahassan O, Engel O, Fisch M, Vetterlein MW. A critical outcome analysis of Asopa single-stage dorsal inlay substitution urethroplasty for penile urethral stricture. World J Urol 2019; 38:1283-1294. [PMID: 31321508 DOI: 10.1007/s00345-019-02871-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/04/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To critically report outcomes from a contemporary series of patients undergoing single-stage Asopa dorsal inlay urethroplasty for penile stricture. METHODS First, we retrospectively evaluated patients who underwent Asopa urethroplasty for penile stricture between 2009 and 2016 at our department. Clinical and surgical characteristics were compared across treatment groups (proximal penile, mid-penile, distal penile). Recurrence-free survival was plotted using Kaplan-Meier curves. Treatment satisfaction was assessed using a validated outcome measurement tool. Second, a literature review was performed through Medline to summarize the available evidence on Asopa urethroplasty and put our own results into context. RESULTS Of 125 patients, 38 (30%), 74 (59%), and 13 (10%) had distal penile, mid-penile, and proximal penile stricture, respectively. Patients with distal strictures were younger and graft length was shorter compared to other groups (P ≤ 0.009). The majority of strictures were iatrogenic (38%), followed by hypospadias related (24%), congenital (17%), traumatic (10%), inflammatory (9%), and post-infectious strictures (2.4%). At a median follow-up of 36 months, overall success rate was 70%. In sensitivity analyses, success rates were only marginally improved to 71% after exclusion of hypospadias- and lichen sclerosus-associated strictures. Patients with mid-penile strictures were significantly more satisfied compared to other groups. Overall, 272 patients from 9 studies in the literature review underwent Asopa urethroplasty and success rates ranged from 73 to 100%. CONCLUSIONS Success rates of Asopa urethroplasty in penile strictures are lower than previously reported. This is most likely due to both complex stricture etiology and surgical history and last resort single-stage surgery in many cases. Pre-operative counseling must consider high recurrence risk and staged urethroplasty should be discussed in selective cases to optimize patient satisfaction.
Collapse
Affiliation(s)
- Valentin Zumstein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Department of Urology, Cantonal Medical Center St. Gallen, St. Gallen, Switzerland
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Luis A Kluth
- Department of Urology, University Medical Center Frankfurt, Frankfurt am Main, Germany
| | - Clemens M Rosenbaum
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Valentin Maurer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Omar Bahassan
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Oliver Engel
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| |
Collapse
|
12
|
Nayak P, Mandal S, Das M. Ventral-inlay buccal mucosal graft urethroplasty for female urethral stricture. Indian J Urol 2019; 35:273-277. [PMID: 31619865 PMCID: PMC6792411 DOI: 10.4103/iju.iju_57_19] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: The aim of the study is to present our initial experience with ventral-inlay buccal mucosal graft urethroplasty (VI-BMGU) in female urethral stricture disease (USD). Methods: Between May 2016 and June 2018, 12 women with USD underwent VI-BMGU. All women were evaluated preoperatively with the American Urological Association (AUA) symptom score, uroflowmetry, calibration with a 12 Fr catheter, and ultrasonography with postvoid residual (PVR) urine measurement. Intraoperative confirmation of stricture was done with a 6 Fr cystoscope. Postoperatively, the women were followed at 3, 6, and 12 months after surgery with AUA symptom score, uroflowmetry, and PVR estimation. Increase in AUA symptom score, maximum flow rate (Qmax) <12 ml/s, and failure to calibrate with 18 Fr catheters were considered as indicative of recurrence of the disease. Results: The mean age of the patients was 41 years. The mean follow-up period was 18 months. All women voided successfully after catheter removal. There was an improvement in AUA symptom score and Qmax and a reduction in PVR at 3, 6, and 12 months. One woman had recurrence of stricture at 6 months and was treated by urethral dilatation followed by the institution of a self-dilatation regimen. The success rate was 92% in our case series. Conclusions: VI-BMGU is a simple and safe method of urethroplasty in women. Studies with a larger sample size and a longer follow-up are required to document the long-term success of this procedure.
Collapse
Affiliation(s)
- Prasant Nayak
- Department of Urology, AIIMS, Bhubaneswar, Odisha, India
| | | | - Manoj Das
- Department of Urology, AIIMS, Bhubaneswar, Odisha, India
| |
Collapse
|
13
|
Onal B, Gultekin MH, Simsekoglu MF. Preputial Graft Ureteroplasty for the Treatment of Complex Ureteral Stricture: A New Surgical Technique and Review of Literature. J Endourol Case Rep 2018; 4:136-139. [PMID: 30182061 PMCID: PMC6114063 DOI: 10.1089/cren.2018.0055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: To present our first experience and 12-month outcomes of the novel technique of onlay preputial graft ureteroplasty (PGU) for complex ureteral stricture. Methods: In December 2016, open onlay PGU was made on a male patient who have proximal stricture of the right ureter. The length of upper ureteral stricture was 50 mm. A 60 mm in length and 15 mm in width preputial graft was harvested from the ventral side of the penis and placed in the ureter as a ventral onlay for ureteroplasty. Operative time, intraoperative, and postoperative complications were recorded properly. Follow-up was performed via clinical assessment of symptoms, renal ultrasound, MR urography, and nuclear scan renography. Results: The new technique was effectively performed without any intraoperative and postoperative complications. Residual hydronephrosis in the right side was found through ultrasonography 3, 6, and 12 months and MR urography 6 months postoperatively. But complaint of the patient's pain passed completely. Conclusions: Within our knowledge, we present the first experience with onlay PGU for proximal ureteral stricture. Twelve-month results indicate that the new technique appears to be an excellent option for proximal ureteral stricture. Our experience is encouraging, and it will find wider application in the complex ureteral lesion.
Collapse
Affiliation(s)
- Bulent Onal
- Department of Urology, University of Istanbul Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Mehmet Hamza Gultekin
- Department of Urology, University of Istanbul Cerrahpasa School of Medicine, Istanbul, Turkey
| | | |
Collapse
|
14
|
Alsagheer GA, Fathi A, Abdel-Kader MS, Hasan AM, Mohamed O, Mahmoud O, Abolyosr A. Management of long segment anterior urethral stricture (≥ 8cm) using buccal mucosal (BM) graft and penile skin (PS) flap: outcome and predictors of failure. Int Braz J Urol 2018; 44:163-171. [PMID: 29211404 PMCID: PMC5815547 DOI: 10.1590/s1677-5538.ibju.2017.0083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 08/13/2017] [Indexed: 11/22/2022] Open
Abstract
Purpose To evaluate the surgical outcome and predictors of failure of substitution urethroplasty using either dorsal onlay buccal mucosal (BM) graft or ventral onlay penile skin flap (PS) for anterior urethral stricture ≥ 8cm. Patients and methods Between March 2010 and January 2016, 50 patients with anterior urethral stricture ≥ 8 cm were treated at our hospital. The surgical outcome and success rate were assessed. The predictors of failure were analyzed using multivariate analysis. Failure was considered when subsequent urethrotomy or urethroplasty were needed. Results Dorsal onlay BM graft was carried out in 24 patients, while PS urethroplasty in 26 patients. There was no significant difference between both groups regarding patients demographics, stricture characteristics or follow-up period. One case in the BM group was lost during follow-up. Stricture recurrence was detected in 7 (30.4%) patients out of BM group while in 6 (23.1%) patients out of PS group (p value= 0.5). No significant differences between both groups regarding overall early and late complications were observed. Occurrence of early complications and the stricture length were the only predictors of failure in univariate analysis, while in multivariate analysis the occurrence of early complications was only significant. Conclusion On short-term follow-up, both dorsal onlay BM graft and ventral onlay PS flap urethroplasty have similar success rates. However, BM graft has a potential advantage to reduce operative time and is also technically easier. The surgeon should avoid early local complications as they represent a higher risk for failure.
Collapse
Affiliation(s)
- Gamal A Alsagheer
- Department of Urology, Qena Faculty of medicine, South Valley University, Egypt
| | - Atef Fathi
- Department of Urology, Qena Faculty of medicine, South Valley University, Egypt
| | | | - Ahmed M Hasan
- Department of Urology, Qena Faculty of medicine, South Valley University, Egypt
| | - Omar Mohamed
- Department of Urology, Qena Faculty of medicine, South Valley University, Egypt
| | - Osama Mahmoud
- Department of Urology, Qena Faculty of medicine, South Valley University, Egypt
| | - Ahmad Abolyosr
- Department of Urology, Qena Faculty of medicine, South Valley University, Egypt
| |
Collapse
|
15
|
Marzorati G, Ghinolfi G, Pachera F, Meazza A. Bladder and buccal mucosa graft in urethral stricture reconstruction. Urologia 2018. [DOI: 10.1177/039156030807500306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose. Our aim was to determine the success of urethroplasty using a free graft of buccal or bladder mucosa for the treatment of complex anterior urethral stricture in adults. Materials and Methods. From October 2000 to February 2005, 11 patients with complex anterior urethral stricture underwent substitution urethroplasty, using mucosal grafts, 6 buccal and 5 bladder. Results. The mean follow-up time was 50 months for 8 out of 11 patients (range 24 to 72). The procedure was successful for 6 patients (75%). Urethral stricture recurred in 2 patients (25%) and was treated by urethrotomy or meatoplasty with positive outcomes. Conclusion. Our limited experience with the reconstruction of a complex stricture of the anterior urethra confirmed that buccal and bladder mucosa grafts are excellent materials for substitution urethroplasty but that case selection is important.
Collapse
Affiliation(s)
- G. Marzorati
- Department of Urology, Niguarda Hospital, Milan (Italy)
| | - G. Ghinolfi
- Department of Urology, Niguarda Hospital, Milan (Italy)
| | - F. Pachera
- Department of Urology, Niguarda Hospital, Milan (Italy)
| | - A. Meazza
- Department of Urology, Niguarda Hospital, Milan (Italy)
| |
Collapse
|
16
|
Bowa K, Manda E. Preputial mucosal graft for urethral repair. Trop Doct 2017; 48:85-87. [PMID: 28836924 DOI: 10.1177/0049475517724924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Urethral stricture disease is the commonest cause of morbidity in urology practice in sub-Saharan Africa. In contrast, prostate disease is commonly cited as the leading cause of urological disease in most urology practices in developed countries. In Africa, the aetiology of urethral stricture disease is compounded by a high prevalence of sexually transmitted infections (STIs), increasing levels of urethral trauma and over-stretched urological services. Thus, patients with prostate disease are treated with long-stay urethral catheters for periods often up to two years. This increases the risk of urethral stricture. The predominant aetiological factor is sexually transmitted infection due to gonococcus or chlamydia. This frequently leads to long severe strictures with spongiofibrosis, especially in the anterior urethra where the periurethral glands are located. These strictures respond poorly to urethral dilatation, optical urethrotomy or primary anastomosis. The majority of strictures in Africa are best treated by open substitution urethroplasty. The gold standard has been the use of buccal mucosa graft for this substitution procedure. This procedure poses a great challenge in most centres with limited resources. In these settings, we have found that the use of a dorsal onlay free preputial graft is easy to perform and gives good results.
Collapse
Affiliation(s)
- Kasonde Bowa
- 1 Michael Chilufya Sata Copperbelt University School of Medicine, Ndola, Zambia
| | - Eliakim Manda
- 2 Ndola Teaching Hospital, Corner Broadyway and Nkana Road, Ndola, Zambia
| |
Collapse
|
17
|
Mukhtar BMB, Spilotros M, Malde S, Greenwell TJ. Ventral-onlay buccal mucosa graft substitution urethroplasty for urethral stricture in women. BJU Int 2017; 120:710-716. [DOI: 10.1111/bju.13970] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bashir M. B. Mukhtar
- Department of Urology; University College London Hospital at Westmoreland Street; London UK
| | - Marco Spilotros
- Department of Urology; University College London Hospital at Westmoreland Street; London UK
| | - Sachin Malde
- Department of Urology; University College London Hospital at Westmoreland Street; London UK
| | - Tamsin J. Greenwell
- Department of Urology; University College London Hospital at Westmoreland Street; London UK
| |
Collapse
|
18
|
Romao RLP, Lorenzo AJ. Vaginectomy and Buccal Mucosa Vaginoplasty as Local Therapy for Pediatric Vaginal Rhabdomyosarcoma. Urology 2017; 102:222-224. [PMID: 28232175 DOI: 10.1016/j.urology.2017.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/01/2017] [Accepted: 02/05/2017] [Indexed: 10/20/2022]
Abstract
We report a case of vaginal rhabdomyosarcoma where vaginectomy with buccal mucosa vaginoplasty was performed to avoid radiation therapy to the young pelvis. The patient presented at 30 months with an exophytic vaginal mass, found to be botryoid rhabdomyosarcoma. After receiving neoadjuvant vincristine, actynomycin D, and cyclophosphamide chemotherapy with good response, she underwent surgery. It was performed using an anterior sagittal approach on the prone position, which allowed for a safe circumferential dissection of the vagina all the way to the cervix and en bloc resection. Two buccal mucosa grafts were used for vaginoplasty. Pathology revealed negative margins. The patient completed therapy in October 2014 and remains disease-free.
Collapse
Affiliation(s)
- Rodrigo L P Romao
- Division of Urology and Division of Pediatric General Surgery, IWK Health Centre and Dalhousie University, Halifax, NS, Canada.
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| |
Collapse
|
19
|
Weinberg AC, Zhao LC. Editorial Comment. Urology 2017; 102:245-246. [PMID: 28065513 DOI: 10.1016/j.urology.2016.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Aaron C Weinberg
- Reconstructive Surgery & Male Sexual Health, NYU Urology Associates, New York, NY
| | - Lee C Zhao
- Reconstructive Surgery & Male Sexual Health, NYU Urology Associates, New York, NY
| |
Collapse
|
20
|
History and evolution of the use of oral mucosa for urethral reconstruction. Asian J Urol 2016; 4:96-101. [PMID: 29264212 PMCID: PMC5717976 DOI: 10.1016/j.ajur.2016.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 02/17/2016] [Accepted: 05/20/2016] [Indexed: 12/03/2022] Open
Abstract
We report here the history and evolution of the use of oral mucosa in reconstructive urethral surgery since it was first used for urethroplasty in 1894. Since that time, many authors have contributed to develop, improve and popularize the use of oral mucosa as a substitute material. Paediatric urologists should be considered pioneers on the use of oral mucosa as they used it to repair primary and failed hypospadias. The use of oral mucosa to repair penile and bulbar urethral strictures was described, for the first time, in 1993. Important evolutions in the technique for harvesting oral mucosa from the cheek were reported in 1996. Today, oral mucosa is considered the gold standard material for any type of anterior urethroplasty in a one- or two-stage repair due to its biological and structural characteristics that make it a highly versatile that is adaptable to any environment required by the reconstructive urethral surgery. As the future approaches, tissue engineering techniques will provide patients with new materials originating from the oral epithelial mucosal cells, which are cultured and expanded into a scaffold. However, the path to reach this ambitious objective is still long and many difficulties must be overcome along the way.
Collapse
|
21
|
Barbagli G, Balò S, Sansalone S, Lazzeri M. Dorsal onlay graft bulbar urethroplasty using buccal mucosa. AFRICAN JOURNAL OF UROLOGY 2016. [DOI: 10.1016/j.afju.2015.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
22
|
Primary dorsal buccal mucosa graft urethroplasty for anterior urethral strictures in patients with lichen sclerosus. Int Urol Nephrol 2016; 48:541-5. [PMID: 26754465 DOI: 10.1007/s11255-015-1202-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 12/25/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To report our ongoing experience with dorsal buccal mucosa graft (BMG) urethroplasty for the primary repair of anterior urethral strictures in patients with lichen sclerosus (LS). PATIENTS AND METHODS A total of 32 men with LS underwent BMG urethroplasty from January 2010 to September 2012. In 27 patients, stricture was limited to the penile urethra, while in five patients, both bulbar and penile urethra were involved. In these five patients, the entire anterior urethra was replaced with BMG. In nine (28.1%) younger patients (mean age 38.2 years, range 33-45), with adverse local conditions and significant scarring, two-stage repair was done. The paired t test was performed on preoperative and postoperative Qmax as well as on preoperative and postoperative post-void residual urine volume, and the Fisher exact test was used to assess success between treatment groups. The chi-squared test was used to compare categorical data. RESULTS The overall success rate was 90.6%. Complications occurred in 9.4% of the patients (3 of 32) including hematoma in two patients and fistula in one patient. In this cohort of patients, mean preoperative Qmax was 6.2 ml per second (range 2.6-10.2) versus 18.2 (range 15.8-21.2) postoperatively (at 9 months), which was statistically significant (p < 0.002). Also, mean preoperative post-void residual urine volume was 110 ml (range 75-180) versus 19 ml (range 10-40) postoperatively at 9 months, which was statistically significant (p < 0.004). CONCLUSION Buccal mucosa is the most reliable graft for repairing anterior urethral strictures in patients with LS. Minimal complications are observed, even in cases of long stenosis completely afflicting anterior urethra.
Collapse
|
23
|
Management of Long-Segment and Panurethral Stricture Disease. Adv Urol 2015; 2015:853914. [PMID: 26779259 PMCID: PMC4686630 DOI: 10.1155/2015/853914] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 11/05/2015] [Indexed: 01/18/2023] Open
Abstract
Long-segment urethral stricture or panurethral stricture disease, involving the different anatomic segments of anterior urethra, is a relatively less common lesion of the anterior urethra compared to bulbar stricture. However, it is a particularly difficult surgical challenge for the reconstructive urologist. The etiology varies according to age and geographic location, lichen sclerosus being the most prevalent in some regions of the globe. Other common and significant causes are previous endoscopic urethral manipulations (urethral catheterization, cystourethroscopy, and transurethral resection), previous urethral surgery, trauma, inflammation, and idiopathic. The iatrogenic causes are the most predominant in the Western or industrialized countries, and lichen sclerosus is the most common in India. Several surgical procedures and their modifications, including those performed in one or more stages and with the use of adjunct tissue transfer maneuvers, have been developed and used worldwide, with varying long-term success. A one-stage, minimally invasive technique approached through a single perineal incision has gained widespread popularity for its effectiveness and reproducibility. Nonetheless, for a successful result, the reconstructive urologist should be experienced and familiar with the different treatment modalities currently available and select the best procedure for the individual patient.
Collapse
|
24
|
Surgical Repair of Bulbar Urethral Strictures: Advantages of Ventral, Dorsal, and Lateral Approaches and When to Choose Them. Adv Urol 2015; 2015:397936. [PMID: 26576149 PMCID: PMC4631846 DOI: 10.1155/2015/397936] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 10/11/2015] [Indexed: 11/23/2022] Open
Abstract
Objectives. To review the available literature describing the three most common approaches for buccal mucosal graft (BMG) augmentation during reconstruction of bulbar urethral strictures. Due to its excellent histological properties, buccal mucosa graft is now routinely used in urethral reconstruction. The best approach for the placement of such a graft remains controversial. Methods. PubMed search was conducted for available English literature describing outcomes of bulbar urethroplasty augmentation techniques using dorsal, ventral, and lateral approaches. Prospective and retrospective studies as well as meta-analyses and latest systematic reviews were included. Results. Most of the studies reviewed are of retrospective nature and majority described dorsal or ventral approaches. Medium- and long-term outcomes of all three approaches were comparable ranging between 80 and 88%. Conclusion. Various techniques of BMG augmentation urethroplasty have been described for repairs of bulbar urethral strictures. In this review, we describe and compare the three most common “competing” approaches for bulbar urethroplasty with utilization of BMG.
Collapse
|
25
|
Soliman MG, Abo Farha M, El Abd AS, Abdel Hameed H, El Gamal S. Dorsal onlay urethroplasty using buccal mucosa graft versus penile skin flap for management of long anterior urethral strictures: a prospective randomized study. Scand J Urol 2014; 48:466-73. [DOI: 10.3109/21681805.2014.888474] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
26
|
Abstract
Male urethral stricture disease is prevalent and has a substantial impact on quality of life and health-care costs. Management of urethral strictures is complex and depends on the characteristics of the stricture. Data show that there is no difference between urethral dilation and internal urethrotomy in terms of long-term outcomes; success rates range widely from 8-80%, with long-term success rates of 20-30%. For both of these procedures, the risk of recurrence is greater for men with longer strictures, penile urethral strictures, multiple strictures, presence of infection, or history of prior procedures. Analysis has shown that repeated use of urethrotomy is not clinically effective or cost-effective in these patients. Long-term success rates are higher for surgical reconstruction with urethroplasty, with most studies showing success rates of 85-90%. Many techniques have been utilized for urethroplasty, depending on the location, length, and character of the stricture. Successful management of urethral strictures requires detailed knowledge of anatomy, pathophysiology, proper patient selection, and reconstructive techniques.
Collapse
Affiliation(s)
- Lindsay A Hampson
- Department of Urology, University of California, 400 Parnassus Avenue, Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA
| | - Jack W McAninch
- Department of Urology, University of California, 400 Parnassus Avenue, Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA
| | - Benjamin N Breyer
- Department of Urology, University of California, 400 Parnassus Avenue, Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA
| |
Collapse
|
27
|
Dorsal onlay buccal mucosal graft urethroplasty in female urethral stricture disease: a single-center experience. Int Urogynecol J 2013; 25:525-30. [DOI: 10.1007/s00192-013-2249-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
|
28
|
Aldaqadossi H, El Gamal S, El-Nadey M, El Gamal O, Radwan M, Gaber M. Dorsal onlay (Barbagli technique) versus dorsal inlay (Asopa technique) buccal mucosal graft urethroplasty for anterior urethral stricture: A prospective randomized study. Int J Urol 2013; 21:185-8. [DOI: 10.1111/iju.12235] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 06/27/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | | | | | - Mohamed Gaber
- Department of Urology; Tanta University; Tanta Egypt
| |
Collapse
|
29
|
Mayr R, Pycha A. [Oral mucosa for reconstructive urethral surgery]. Urologe A 2013; 52:662-7. [PMID: 23657770 DOI: 10.1007/s00120-013-3118-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The use of oral mucosa for urethral stricture repair has become the standard approach in reconstructive urethral surgery. Compared to other tissues oral mucosa shows several advantages, such as simple harvesting, good urine tolerance and low harvesting morbidity. For defects of the male bulbar urethra measuring 2 cm or longer, urethral reconstruction with oral mucosa is the procedure of choice. The oral mucosa graft can be used as an inlay or as an onlay graft. Most repairs can be completed in one stage but for complex strictures two stages are needed.
Collapse
Affiliation(s)
- R Mayr
- Abteilung für Urologie, Zentralkrankenhaus Bozen, Lorenz Böhler Straße 5, I-39100 Bozen, Italien
| | | |
Collapse
|
30
|
Barbagli G, Sansalone S, Djinovic R, Romano G, Lazzeri M. Current controversies in reconstructive surgery of the anterior urethra: a clinical overview. Int Braz J Urol 2013; 38:307-16; discussion 316. [PMID: 22765862 DOI: 10.1590/s1677-55382012000300003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2012] [Indexed: 11/21/2022] Open
Abstract
We performed an overview of the surgical techniques suggested for the treatment of anterior urethral strictures using MEDLINE. In applying the MEDLINE search, we used the ″MeSH″ (Medical Subject Heading) and "free text" protocols. The MeSH search was conducted by combining the following terms: "urethral stricture", "flap", "graft", "oral mucosa", "urethroplasty", "urethrotomy" and "failed hypospadias". Multiple "free text" searches were performed individually applying the following terms through all fields of the records: "reconstructive urethral surgery", "end-to-end anastomosis", "one-stage", "two stage". Descriptive statistics of the articles were provided. Meta-analyses were not employed. Seventy-eight articles were determined to be germane in this review. Six main topics were identified as controversial in anterior urethra surgery: the use of oral mucosa vs penile skin; the use of free grafts vs pedicled flaps in penile urethroplasty; the use of grafts vs anastomotic repair in bulbar urethral strictures; the use of dorsal vs ventral placement of the graft in bulbar urethroplasty; the use of definitive perineal urethrostomy vs one-stage repair in complex urethral strictures; the surgical options for patients with failed hypospadias repair. Different points of view are documented and presented in the literature by various authors from different countries. The aim of this clinical overview is to survey the main controversial issues in surgical reconstruction of the anterior urethra focusing on the use of flap or graft, substitute material, type of surgery and challenging situations, such as failed hypospadias or complex urethral stricture repair.
Collapse
Affiliation(s)
- Guido Barbagli
- Center for Reconstructive Urethral Surgery, Arezzo, Italy
| | | | | | | | | |
Collapse
|
31
|
Lumen N, Oosterlinck W, Hoebeke P. Urethral reconstruction using buccal mucosa or penile skin grafts: systematic review and meta-analysis. Urol Int 2012; 89:387-94. [PMID: 22889835 DOI: 10.1159/000341138] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Different types of grafts have been described in urethral reconstruction (UR), with penile skin graft (PSG) and buccal mucosa graft (BMG) as the most frequently used ones. It still remains unclear whether one graft is superior in terms of success when compared to the other. MATERIAL AND METHODS A systematic review of the literature was performed searching the MEDLINE database with the following search strategy: 'urethroplasty' AND 'penile skin'/ 'urethroplasty' AND 'buccal mucosa'. 266 and 144 records were retrieved for urethroplasty with PSG and BMG, respectively. These records were reviewed to identify papers where PSG and BMG were used in UR and where individualized data on success were available within the same series. RESULTS 18 papers were found eligible for further analysis. In total, 428 and 483 patients were respectively treated with PSG or BMG. If available, follow-up duration was 64.1 versus 42.1 months (p < 0.0001) and stricture length 6.2 versus 4.6 cm (p < 0.0001) for PSG and BMG, respectively. Success of UR with PSG was 81.8 versus 85.9% with BMG (p = 0.01). CONCLUSIONS Success of UR using BMG is significantly better compared to PSG. Results might be seriously biased by a longer follow-up duration and stricture length for PSG compared to BMG.
Collapse
Affiliation(s)
- N Lumen
- Department of Urology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium. lumennicolaas @ hotmail.com
| | | | | |
Collapse
|
32
|
Erickson BA, Breyer BN, McAninch JW. Single-stage segmental urethral replacement using combined ventral onlay fasciocutaneous flap with dorsal onlay buccal grafting for long segment strictures. BJU Int 2011; 109:1392-6. [PMID: 21880103 DOI: 10.1111/j.1464-410x.2011.10483.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED Study Type--Therapy (case series). Level of Evidence 4. What's known on the subject? And what does the study add? Single-stage urethral segment replacement has historically poor outcomes and two-stage repairs are now more common. We present a novel approach to the single-stage repair with initial outcomes similar to two-stage repairs. OBJECTIVE • To present our experience with repairing long-segment urethral strictures in a single-stage using a combined tissue-transfer technique. PATIENTS AND METHODS • In all, 14 men underwent urethroplasty where a segment of urethra was completely replaced using a dorsal onlay buccal mucosa graft and a ventral onlay fasciocutaneous flap in a single stage. • Primary success was defined as an open urethra at >6 months follow-up with no need for additional surgical intervention. • Secondary success was defined as the need for a single postoperative endoscopic procedure before stricture stabilization. • Failure was the need for multiple endoscopic procedures, repeat urethroplasty, urinary diversion or intermittent dilatation. RESULTS • The mean (SD) stricture length was 9.75 (4.6) cm. The mean (SD) neourethral length was 5.4 (2.7) cm. Stricture location was penile/bulbar in 12 men, and bulbar alone in two. Primary success was achieved in nine of the 14 men at a median (range) follow-up of 2.5 (0.5-9.43) years. • The mean (SD) time to recurrence in the five initial failures was 340 (376) days. • Secondary success was achieved in two men after a single endoscopic procedure for an overall success in 11 of 14 men. • Patients that recurred had longer strictures (12.8 vs 8.7 cm, P= 0.04) than initial successes, but neourethral lengths were similar (6.2 vs 5.1 cm, P= 0.5). • In all, three of the 14 men failed, two of whom required a repeat urethroplasty. CONCLUSIONS • Our initial outcomes were favourable using the combined tissue-transfer technique for segmental urethral replacement with initial and secondary success rates similar to those reported for two-stage repairs. • This technique is not suitable for all patients as it requires healthy penile skin, but appears to be effective when a single-stage repair is desirable.
Collapse
|
33
|
Outcome of Dorsal Onlay Buccal Mucosa Substitution Urethroplasty in Long Strictures of Anterior Urethra. Med J Armed Forces India 2011; 63:12-4. [PMID: 27407928 DOI: 10.1016/s0377-1237(07)80097-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Accepted: 07/31/2006] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The surgical treatment of adult anterior urethral strictures is constantly evolving. Controversy exists over the best means of reconstructing the anterior urethra. METHODS Twelve patients underwent buccal mucosal urethroplasty for long segment anterior urethral stricture between 2003 and 2005 . Eleven patients with a salvageable urethral plate were treated with one stage dorsal onlay urethroplasty, using a perineal or circumcoronal incision. One patient with a severely scarred urethral plate underwent two-stage urethroplasty. RESULTS At a mean follow up of 14.2 months (range 2 to 26) one (8.3%) patient had short recurrent stricture, which was treated with optical urethrotomy. The mean maximal urine flow rate improved from 8.3 ml/sec to 18.1 ml/sec after the surgery. There were no donor site complications. All patients had a normal slit like meatus and none had chordee or erectile dysfunction. CONCLUSION In long stricture of anterior urethra, dorsal onlay buccal mucosa urethroplasty provides excellent intermediate term results with a normal, wide caliber urethra.
Collapse
|
34
|
Hussein MM, Moursy E, Gamal W, Zaki M, Rashed A, Abozaid A. The Use of Penile Skin Graft Versus Penile Skin Flap in the Repair of Long Bulbo-penile Urethral Stricture: A Prospective Randomized Study. Urology 2011; 77:1232-7. [DOI: 10.1016/j.urology.2010.08.064] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 08/05/2010] [Accepted: 08/21/2010] [Indexed: 11/15/2022]
|
35
|
A systematic review of graft augmentation urethroplasty techniques for the treatment of anterior urethral strictures. Eur Urol 2011; 59:797-814. [PMID: 21353379 DOI: 10.1016/j.eururo.2011.02.010] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 02/02/2011] [Indexed: 12/19/2022]
Abstract
CONTEXT Reconstructive surgeons who perform urethroplasty have a variety of techniques in their armamentarium that may be used according to factors such as aetiology, stricture position, and length. No one technique is recommended. OBJECTIVE Our aim was to assess the reported outcomes of the various techniques for graft augmentation urethroplasty according to site of surgery. EVIDENCE ACQUISITION We performed an updated systematic review of the Medline literature from 1985 to date and classified the data according to the site of surgery and technique used. Data are also presented on the type of graft used and the follow-up methodology used by each centre. EVIDENCE SYNTHESIS More than 2000 anterior urethroplasty procedures have been described in the literature. When considering the bulbar urethra there is no significant difference between the average success rates of the dorsal and the ventral onlay procedures, 88.4% and 88.8% at 42.2 and 34.4 mo in 934 and 563 patients, respectively. The lateral onlay technique has only been described in six patients and has a reported success rate of 83% at 77 mo. The Asopa and Palminteri techniques have been described in 89 and 53 patients with a success rate of 86.7% and 90.1% at 28.9 and 21.9 mo, respectively. When considering penile strictures, the success rate of the two-stage penile technique is significantly better than the one-stage penile technique, 90.5% versus 75.7% as calculated for 129 and 432 patients, respectively, although the follow-up of one-stage procedures was longer at 32.8 mo compared with 22.2 mo. CONCLUSIONS There is no evidence in the literature of a difference between one-stage techniques for urethroplasty of the bulbar urethra. The two-stage technique has better reported outcomes than a one-stage approach for penile urethroplasty but has a shorter follow-up.
Collapse
|
36
|
Schwentner C, Seibold J, Colleselli D, Alloussi SH, Schilling D, Stenzl A, Radmayr C. Single-stage dorsal inlay full-thickness genital skin grafts for hypospadias reoperations: extended follow up. J Pediatr Urol 2011; 7:65-71. [PMID: 20172763 DOI: 10.1016/j.jpurol.2010.01.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 01/29/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To report our extended experience with single-stage genital skin graft urethroplasty for complex hypospadias reoperations. MATERIALS AND METHODS Thirty-one patients with failed hypospadias surgery were included. The urethral plate had been removed or was scarred in all. After excision of fibrotic tissue a free full-thickness skin graft was quilted to the corpora cavernosa. The neourethra was then tubularized followed by glanuloplasty. Voiding cystograms, urethral ultrasound and flow measurements were performed in all. Outcome was considered a failure when postoperative instrumentation was needed. RESULTS Follow up was 78.45 +/- 18.18 months. Shaft skin was used in 13 and internal prepuce in 18. Average graft length was 3.66 +/-1.56cm. Eighteen patients required glanuloplasty. Initial graft healing was successful in all. There was no postoperative infection involving the inlay. We did not note complications from the graft donor sites. Four patients underwent redo surgery yielding a complication rate of 12.9%. Urethral stricture of the proximal anastomosis was most frequent. CONCLUSIONS This single-stage approach using dorsal inlay skin grafts is reliable, creating a substitute urethral plate in the long term. Complication rates are equivalent to those of staged strategies. This is a safe option for hypospadias reoperations if the urethral plate is compromised.
Collapse
|
37
|
Zhao M, Li Y, Tang Y, Chen W, Yang Z, Li Q, Zhou C, Li F, Zhou Y. Two-stage repair with buccal mucosa for severe and complicated hypospadias in adults. Int J Urol 2011; 18:155-61. [DOI: 10.1111/j.1442-2042.2010.02684.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
38
|
Goyal A, Singh MV, Dickson AP. Oral Mucosa Graft for Repair of Hypospadias: Outcomes at Puberty. J Urol 2010; 184:2504-8. [DOI: 10.1016/j.juro.2010.08.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Anju Goyal
- Department of Pediatric Urology, Royal Manchester Children Hospital, Manchester, England
| | - Michael V.A. Singh
- Department of Pediatric Urology, Royal Manchester Children Hospital, Manchester, England
| | - Alan P. Dickson
- Department of Pediatric Urology, Royal Manchester Children Hospital, Manchester, England
| |
Collapse
|
39
|
Lumen N, Monstrey S, Goessaert AS, Oosterlinck W, Hoebeke P. Urethroplasty for strictures after phallic reconstruction: a single-institution experience. Eur Urol 2010; 60:150-8. [PMID: 21145648 DOI: 10.1016/j.eururo.2010.11.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 11/10/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND Treatment recommendations for strictures after phalloplasty are lacking. OBJECTIVE Our aim was to evaluate the outcome of urethroplasty for strictures after phalloplasty and to provide treatment recommendations based on this experience. DESIGN, SETTING, AND PARTICIPANTS One hundred and eighteen urethroplasties were performed in 79 patients. Mean patient age was 37.6 yr. Mean follow-up was 39 mo. INTERVENTION Different types of urethroplasty were used: meatotomy, Heineke-Mikulicz principle (HMP), excision and primary anastomosis (EPA), free graft urethroplasty (FGU), pedicled flap urethroplasty (PFU), two-stage urethroplasty (TSU), and perineostomy followed by urethral reconstruction (PUR). MEASUREMENTS Stricture recurrence was defined as the need for additional instrumentation or surgery. RESULTS AND LIMITATIONS Mean stricture length was 3.6 cm. Stricture location was at the meatus, phallic urethra, anastomosis, fixed part, and different locations in 18, 28, 48, 15, and 9 urethroplasties, respectively. Stricture recurrence was observed in 44 urethroplasties (41.12%). Stricture recurrence rate for meatotomy, HMP, EPA, FGU, PFU, TSU, and PUR was 25%, 42.11%, 42.86%, 50%, 40%, 30.3%, and 61.9%, respectively. CONCLUSIONS The main stricture location after phalloplasty is the anastomosis between the phallic and the fixed part. Urethroplasty for strictures after phalloplasty is associated with a relatively high recurrence rate. TRIAL REGISTRATION EC UZG 2007/434.
Collapse
Affiliation(s)
- Nicolaas Lumen
- Department of Urology, Ghent University Hospital, Ghent, Belgium.
| | | | | | | | | |
Collapse
|
40
|
Zimmerman WB, Santucci RA. A simplified and unified approach to anterior urethroplasty. Nat Rev Urol 2010; 7:386-91. [PMID: 20531384 DOI: 10.1038/nrurol.2010.79] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The management of patients with urethral stricture can be a complex process. However, with the appropriate tools, the urologist experienced in urethral surgery can manage most cases without too much difficulty. Here, we describe three surgical techniques--anastomotic urethroplasty, buccal mucosal graft-onlay urethroplasty and the two-staged Johanson urethroplasty--that, in our experience, can accommodate the majority of patients with urethral stricture and provide excellent long-term results. Diagnosis and evaluation of candidacy for each of the surgical techniques are important aspects of treatment planning, and are also described. The aim of the article is to increase the awareness of the technique and application of these three urethroplasty procedures, which can be implemented by all urologists who actively care for and surgically treat patients with urethral stricture disease.
Collapse
Affiliation(s)
- W Britt Zimmerman
- The Center for Urologic Reconstruction, Detroit Medical Center, Harper Professional Building, Suite 1017, 4160 John R Street, Detroit, MI 48201, USA
| | | |
Collapse
|
41
|
[Oral mucosa graft urethroplasty for complicated urethral strictures]. Nihon Hinyokika Gakkai Zasshi 2010; 101:547-53. [PMID: 20387514 DOI: 10.5980/jpnjurol.101.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We evaluated the efficacy and outcome of one-stage oral mucosa graft urethroplasty, which is currently the procedure of choice for treating lengthy and complicated urethral strictures not amenable to excision and primary end-to-end anastomosis. PATIENTS AND METHODS Seven patients 33 to 74 years old (mean age = 53.7) underwent one-stage oral mucosa graft urethroplasty for a stricture in either the bulbar urethra (four patients), penile urethra (two patients), or pan-anterior urethra (one patient). Three of the strictures were due to trauma, one was due to inflammation, and one was due to a failed hypospadia repair. The other two were iatrogenic. All patients had previously undergone either internal urethrotomy or repeated urethral dilation. Three patients received a tube graft, three received a ventral onlay, and one received a dorsal onlay. A free graft of oral mucosa was harvested from the inside of each patient's left cheek, and if necessary to obtain a sufficient length, the harvest was extended to include mucosa from the lower lip and the right cheek. The graft lengths ranged from 2.5 to 12 cm (mean = 4.6 cm). A urethral catheter was left in place for 3 weeks postoperatively. RESULTS While no severe complications at the donor site were observed during follow-up periods ranging from 3 to 55 months (mean = 14 months), two patients who had received a tube graft developed distal anastomotic ring strictures that were managed by internal urethrotomy. The other five required no postoperative urological procedure even though one who had received a ventral onlay developed a penoscrotal fistula. CONCLUSION Oral mucosa is an ideal urethral graft, and oral mucosa graft urethroplasty is an effective procedure for repairing complicated urethral strictures involving long portions of the urethra.
Collapse
|
42
|
Lumen N, Hoebeke P, Oosterlinck W. Urethroplasty for urethral strictures: Quality assessment of an in-home algorithm. Int J Urol 2010; 17:167-74. [DOI: 10.1111/j.1442-2042.2009.02435.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
43
|
Mathur RK, Sharma AK, Odiya S. Tunica albuginea urethroplasty for anterior urethral strictures: A urethroscopic analysis. Int J Urol 2009; 16:751-5. [DOI: 10.1111/j.1442-2042.2009.02356.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
44
|
Pisapati VM, Paturi S, Bethu S, Jada S, Chilumu R, Devraj R, Reddy B, Sriramoju V. Dorsal Buccal Mucosal Graft Urethroplasty for Anterior Urethral Stricture by Asopa Technique. Eur Urol 2009; 56:201-5. [PMID: 18555586 DOI: 10.1016/j.eururo.2008.06.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 06/03/2008] [Indexed: 10/22/2022]
|
45
|
Ye WJ, Ping P, Liu YD, Li Z, Huang YR. Single stage dorsal inlay buccal mucosal graft with tubularized incised urethral plate technique for hypospadias reoperations. Asian J Androl 2008; 10:682-6. [PMID: 18478167 DOI: 10.1111/j.1745-7262.2008.00398.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIM To report the experience with single stage dorsal inlay buccal mucosal grafts using the Snodgrass technique for complex redo cases. METHODS From May 2004 to December 2005, a total of 53 patients aged from 3 to 34 years old (average 11.62 +/- 7.18 years) with failed previous hypospadias surgery were included in the present study. Indications included urethral strictures and repair breakdown. The unhealthy urethra was unroofed from the meatus in the ventral midline, a buccal mucosal graft was inlayed between the incised urethral plate and fixed to the corpora cavernosa. The neourethra was tubularized, and covered with subcutaneous (dartos) tissue and penile skin. Glanuloplasty was also performed in all cases. Outcome analysis included clinical follow-up, and endoscopy in 2 selected cases. RESULTS The buccal mucosal graft was 3.0-7.5 cm in length and 0.7-2.0 cm in width. All patients required glanuloplasty, with buccal mucosal grafts extended to the tip of the glans. After a follow-up of 14-30 months (mean 22.6 months), the total complication rate was 15.1%, with five cases of fistula and three cases of stricture. CONCLUSION Inlaying dorsal buccal mucosal grafts applying the Snodgrass technique is a reliable method for creating a substitute urethral plate for tubularization. The recurrent rate of urethral stricture and fistula is at an acceptable level for redo cases. This approach represents an effective, simple and safe option for reoperations.
Collapse
Affiliation(s)
- Wei-Jing Ye
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | | | | | | | |
Collapse
|
46
|
Souza GF, Calado AA, Delcelo R, Ortiz V, MacedoJr. A. Histopathological evaluation of urethroplasty with dorsal buccal mucosa: an experimental study in rabbits. Int Braz J Urol 2008; 34:345-51; discussion 351-4. [DOI: 10.1590/s1677-55382008000300012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2008] [Indexed: 11/22/2022] Open
|
47
|
Patterson JM, Chapple CR. Surgical Techniques in Substitution Urethroplasty Using Buccal Mucosa for the Treatment of Anterior Urethral Strictures. Eur Urol 2008; 53:1162-71. [PMID: 18609764 DOI: 10.1016/j.eururo.2007.10.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
48
|
Randomized comparative study between buccal mucosal and acellular bladder matrix grafts in complex anterior urethral strictures. J Urol 2008; 179:1432-6. [PMID: 18295282 DOI: 10.1016/j.juro.2007.11.101] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2007] [Indexed: 12/11/2022]
Abstract
PURPOSE Urethral strictures have been a reconstructive dilemma for many years due to the limited availability of tissue substitutes and incidence of recurrence. Buccal mucosal grafts have been a favored material in instances where penile skin is unavailable due to its durability and excellent graft survival. Recently collagen based matrices derived from the bladder have been used successfully in patients with stricture disease and hypospadias. We performed a randomized comparative study to assess the outcome of the acellular bladder matrix compared to buccal mucosa in patients with complex urethral strictures. MATERIALS AND METHODS Human demineralized bone matrix, obtained from cadaveric donors, was processed and prepared for use as an off-the-shelf material. Thirty patients with stricture 21 to 59 years old (mean 36.2) were enrolled and assessed using a standard protocol. The stricture length ranged from 2 to 18 cm (mean 6.9), of which 11 patients had bulbar, 7 had pendulous and 12 had combined bulbopendulous strictures. Of the 30 patients 7 had received no previous intervention while the remaining 23 had undergone 1 to 7 procedures (mean 1.9). All patients were randomized and alternatively assigned to receive either buccal mucosa or decellularized bladder [corrected] matrix and underwent an onlay procedure. RESULTS All patients except 2 who were lost during followup were followed for 18 to 36 months (mean 25). In patients with a healthy urethral bed (less than 2 prior operations) the success rate of buccal mucosa grafts (10 of 10) was similar to the bladder matrix grafts (8 of 9) in terms of patency. In patients with an unhealthy urethral bed (more than 2 prior operations) only 2 of 6 patients with a bladder matrix graft were successful, whereas all 5 patients with a buccal mucosa graft had a patent urethra. Postoperative uroflowmetry showed significant voiding improvement in both groups. Histology of the graft biopsies showed normal urethral tissue characteristics. CONCLUSIONS This study demonstrates that the use of acellular bladder matrix is a viable option for urethral repair. Demineralized bone matrix as an off-the-shelf biomaterial achieves the best results in patients with a healthy urethral bed, no spongiofibrosis and good urethral mucosa.
Collapse
|
49
|
Barbagli G, Morgia G, Lazzeri M. Dorsal Onlay Skin Graft Bulbar Urethroplasty: Long-Term Follow-Up. Eur Urol 2008; 53:628-33. [PMID: 17728049 DOI: 10.1016/j.eururo.2007.08.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Accepted: 08/10/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To report retrospectively long-term follow-up in a homogeneous group of patients who underwent dorsal onlay skin graft bulbar urethroplasty and to investigate which factors might influence long-term outcome. METHODS Thirty-eight patients, with an average age of 43 yr, underwent dorsal onlay skin graft (#12 ventral penile skin and #26 preputial mucosa) bulbar urethroplasty from 1994 to 2000. Of 38 patients, 23 (60.5%) had undergone prior endoscopic procedures. Preoperative evaluation included clinical history, physical examination, retrograde and voiding urethrography, and urethral sonography. Three weeks after surgery, voiding cystourethrography was performed. Patients were followed-up with a clinical evaluation and specific diagnostic tests every 4 mo in the first year and every 12 mo thereafter. Clinical outcome was considered a failure when postoperative instrumentation, including dilation, was needed. RESULTS Average follow-up was 111 mo (range, 80-149). Of 38 cases, 25 (65.8%) were successful and 13 (34.2%) failures. Patients with stricture length > 6 cm and a previous history of urethrotomies or dilatations seemed to have a higher risk of failure, but this observation was only a trend and did not reach levels of statistical significance. CONCLUSIONS Penile skin used as dorsal onlay graft for bulbar urethral reconstruction in a homogeneous series of patients showed a success rate ranging from 90% at short-term follow-up to 66% after long-term follow-up. There was no evidence for particular risk factors (length of stricture, number of dilatations and urethrotomies) for failure.
Collapse
Affiliation(s)
- Guido Barbagli
- Center for Reconstructive Urethral Surgery, Arezzo, Italy
| | | | | |
Collapse
|
50
|
Oosterlinck W, Lumen N, Van Cauwenberghe G. Traitement chirurgical des sténoses de l'urètre: aspects techniques. ACTA ACUST UNITED AC 2007; 41:173-207. [DOI: 10.1016/j.anuro.2007.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|