V2-13: DORSAL INLAY BUCCAL MUCOSAL GRAFT (BMG) URETHROPLASTY IN THE SINGLE-STAGE MANAGEMENT OF LONG ANTERIOR URETHRAL STRICTURES

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Introductions and Objectives
The management of long anterior urethral strictures (extending from the meatus to the bulbar urethra) is challenging. Selected cases with an adequate urethral plate may benefit from single-stage reconstruction. In this study, we present our technique and results of dorsal inlay BMG urethroplasty for long anterior urethral strictures.

Methods
Between 2010 and 2012, 13 patients (mean age: 43.7 years) underwent dorsal inlay BMG urethroplasty for long anterior urethral strictures. All except 3 patients had a history of previous urethral dilatations and/or internal urethrotomy. The cause of stricture was lichen sclerosus in 8 and inflammatory/idiopathic in 5. Preoperative evaluation included subjective assessment of the severity of symptoms with the AUA symptom score, uroflowmetry with residual urine volume determination, combined retrograde urethrography (RU) and voiding cystourethrography (VCUG), and urethrocystoscopy by using a pediatric ureterorenoscope. Dorsal inlay BMG technique was used in all cases: the urethra was split along the stricture both ventrally and dorsally without mobilizing it from its bed, and the BMG was secured in the dorsal urethral defect. The urethra was then retubularized in one stage. Patients were followed with AUA symptom questionnaire and uroflowmetry at 3 monthly intervals in the first year and annually thereafter. Cure was defined as patient satisfaction associated with a normal-appearing flow curve at the last postoperative visit and the absence of any restenosis requiring additional intervention.

Results
The mean stricture length was 13 cm (range: 10-15 cm) and the mean BMG length was 14.5 cm (range: 11-17 cm). The mean operation time was 170 min (130-240 min.). Average hospital stay was 2.3 days (1-7). Cure was achieved in 11 of 13 men (84.6%) during a median follow-up of 24 (range: 6-36) months. Two patients had a stricture at the proximal part of the graft and were managed by visual internal urethrotomy. Qmax values at the last follow-up were significantly improved as compared to preoperative measurements (mean 22.7±9.3 ml/s versus 6.4±5.9 ml/sec, p=0.001). The mean AUA symptom scores were also significantly improved (26.3±5.2 preoperatively vs. 6.2±2.8 postoperatively, p
Conclusions
Dorsal inlay BMG urethroplasty seems as an effective method for the management of long anterior urethral strictures. In this technique, the procedure is simplified by not mobilizing or dissecting the urethra, which potentially preserves its blood supply coming from both circumflex and perforating vessels.

Funding: none