V12-13: Two-sided dorsal plus ventral oral graft urethroplasty for long anterior urethral strictures
Substitution urethroplasty provides good functional results in bulbar and penile urethral strictures. However, treatment of long(extending from external meatus to bulbar urethra) and tight strictures remains a challenge. One-sided (dorsal or ventral) substitution urethroplasty may not be sufficient in long strictures with a narrow urethral plate. In recent years, we have opted to use two-sided oral mucosa graft (OMG) in such cases. We describe our technique of two-sided OMG urethroplasty in long and tight strictures.
Among the 83 men that underwent anterior urethroplasty in our clinic between 2010 and 2015, 23 (27.7%) had long(>80mm) or multiple strictures. Clinical evaluation included assessment of subjective symptoms with the AUA symptom score and patient-reported outcome measure for urethral stricture (USS-PROM), uroflowmetry, and combined retrograde urethrography/voiding cystourethrography. We performed two-sided urethral augmentation in patients with a tight stricture (ie. urethral caliber
Two-sided OMG technique was used in 7 patients. Mean stricture length was 137.9±40.4 mm (range: 80 to 190 mm). With a median follow-up of 32 months (range: 6 to 58), 85.7% were cured. One patient developed recurrent stricture and underwent internal urethrotomy. Mean AUA symptom score decreased from 19.8±10.2 preoperatively to 3.2±1.6 postoperatively(p=0.02). Similarly, baseline USS-PROM LUTS score decreased from 10±4.6 to 1.5±1.4 postoperatively. Mean maximum flow rate (ml/sec) increased from 4.2±1.6 preoperatively to 28.2±10.8 postoperatively(p=0.03).
Two-sided dorsal plus ventral oral graft urethroplasty appears as an effective technique for long anterior urethral strictures.The two-sided OMG may facilitate the reconstruction of a wide-caliber urethral lumen in tight strictures.