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Results of buccal mucosa grafts for repairing long bulbar urethral strictures.

Abstract：

OBJECTIVES:To report the medium-term results at our institution of repairing long bulbar urethral strictures with buccal mucosal grafts. PATIENTS AND METHODS:Between January 2003 and June 2007, a buccal mucosa graft repair was used in 34 patients with recurrent bulbar strictures >2 cm. The follow-up included uroflowmetry with an ultrasonographic estimate of residual volume at 3 months, 1 year and yearly thereafter, or at the onset of obstructive voiding symptoms. A retrograde urethrogram with a voiding cysto-urethrogram was taken at 6 months. Flexible urethroscopy was used whenever a recurrent stricture was suspected. A successful outcome was defined as normal voiding with no stricture on the voiding cysto-urethrogram and no need for subsequent instrumentation. RESULTS:The median (range) age of the patients was 55.5 (23-74) years. The mean (sd) preoperative maximum flow rate was 6.6 (2.5) mL/s with a mean (sd) residual volume of 51.7 (89.7) mL. Seven patients (21%) had had one or more previous urethral dilatations, 15 (44%) had undergone one or more internal urethrotomies and 10 (30%) received both treatments. Eight patients (24%) had previous open urethral surgery; two had no previous treatment. A dorsal onlay technique was used in 30 patients, a ventral onlay in one, a combined technique (dorsal onlay and ventral fasciocutaneous flap) in two and a two-stage buccal mucosa urethroplasty in one. The mean (sd) operative duration was 147 (36) min, and the stricture length and buccal mucosa graft length were, respectively, 3.2 (1.2) cm and 4.4 (0.6) cm. Follow-up was available in 33 patients (97%) with a mean of 23 (15.4) months. The success rate was then 94%. Both failures occurred within the first year and were managed successfully by internal urethrotomy. The mean (sd) postoperative maximum flow rate was 20 (11) mL/s with a mean (sd) residual volume of 46 (68) mL. There were no medium-term donor-site complications. Postmicturition dribbling was noted in eight patients (24%). None of the patients had de novo impotence or urinary incontinence, and to date no patient has needed a repeat open reconstruction. CONCLUSION:Our results show that in patients with bulbar urethral strictures of >2 cm, urethroplasty using buccal mucosa is feasible, with very encouraging medium-term results. We confirm that this type of reconstruction could be considered the standard of care for bulbar strictures of >2 cm.

journal_name

BJU Int

journal_title

BJU international

authors

Fransis K,Vander Eeckt K,Van Poppel H,Joniau S

doi

10.1111/j.1464-410X.2009.08848.x

subject

Has Abstract

pub_date

2010-04-01 00:00:00

pages

1170-2

issue

eissn

1464-4096

issn

1464-410X

pii

BJU8848

journal_volume

105

pub_type

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Results of buccal mucosa grafts for repairing long bulbar urethral strictures.