V1-03: Membranous urethroplasty using dorsal onlay buccal mucosal graft for strictures associated with TURP or radiation therapy
To present the application of buccal mucosa graft dorsal onlay urethroplasty for membranous urethral stricture caused by TURP or radiation therapy.
All patients were confirmed to have membranous involvement using radiographic and endoscopic evaluation. Dorsal onlay urethroplasty via a one-sided urethral dissection as described by Kulkarni and Barbagli was performed in all patients. This technique was modified by carrying dorsal urethrotomy proximally through the membranous urethra and sharply excising a wedge of intracrural tissue beyond stricture area to make adequate room for buccal mucosa grafting. _x000D_ All patients were followed at 4, 8, 12 months and then yearly for assessment of functional and patient-reported outcomes.
Fifteen consecutive men with a mean age 68 years (47-72) post membranous urethral stricture repair were included. Seven patients had prior TURP, 6 had prior radiation therapy with prostate in situ, and 2 patients had radical prostatectomy followed by adjuvant radiation therapy. At a mean of 17 months (4-37) follow up, one patient required an additional procedure for stricture recurrence. No patient developed de novo incontinence. Improvement was seen with respect to mean maximum flow rate (4 to 21 cc/sec), PVR (90 to 50 cc), and International Prostate Symptom Scores (23 to 9).
Membranous urethral strictures can be effectively treated using this buccal mucosa graft dorsal onlay technique which avoids extensive urethral mobilization, urethral transection, and perirectal dissection. The described technique did not compromise continence in this group of patients. Additionally, in this series dorsal buccal mucosal graft take is demonstrated in patients with prior history of radiation therapy. _x000D_ _x000D_