V1032: DOUBLE BUCCAL MUCOSA GRAFT-AUGMENTED PERINEAL URETHROPLASTY IN TIGHT BULBAR URETHRAL STRICTURES
VideoIntroduction and Objectives
The optimal management of bulbar urethral strictures is controversial. Augmented urethroplasty is a widely-used strategy due to the advantages of preserving the urethral plate and avoiding unnecessary urethral mobilization and transection of spongiosum vascularity. Combined anterior+posterior double buccal mucosa grafting (dBMG) has been favored in particularly narrow strictures since it offers the possibility of creating a wider-caliber urethral lumen. We present our technique and results with dBMG in narrow bulbar urethral strictures.
Fifteen patients (mean age: 37 years, range: 23-65) with bulbar urethral strictures were treated with dBMG-augmented perineal urethroplasty between 2006 and 2011. All patients were cytostomized and had undergone at least one prior endoscopic treatments (mean: 3.8 times, range: 1-9) and multiple dilatations. The stricture was evaluated with preoperative retrograde urethrogram+antegrade cystogram, and intraoperative radiographic assessment of the defect between the tips of 2 Benique sounds advanced through the cytostomy tract and urethra. Mean stricture length was 3 cm. (range: 1.5-4 cm). The operation stages were: reverse Y incision, separation of bulbocavernous muscles, ventral sagittal urethrotomy and entry of strictured urethra, midline incision of the dorsal urethra down to tunica albuginea and dissection of incision margins to provide bed for the BMG. The first BMG was quilted to the corpus cavernosum as dorsal inlay and second BMG was sutured to the margins of the ventral urethral incision as onlay, followed by approximation of bulbocavernous muscles over the urethra. A 16-18F catheter was left for 2 to 3 weeks. Retrograde urethrograms were routinely obtained 4 weeks after catheter removal, and cystoscopy was performed in the presence of obstructive symptoms. Failure was defined as any need for postoperative intervention, including urethrotomy or dilatation.
With a mean follow-up of 28 months (range: 6-56), 13 (86.6%) procedures were successful. Two patients required internal urethrotomy due to re-stricture of less than 1.5 cm. All patients were free of their cytostomy at the last follow-up, and mean postoperative peak urinary flow rate was 19.2 ml per second (range: 14-32).
Combined dBMG urethroplasty is a viable option for reconstructing tight bulbar urethral strictures in terms of preserving the urethral plate and its vasculature, and enabling the formation of a physiological, wide-caliber urethra.