Single-stage reconstruction of complex anterior urethral strictures using overlapping dorsal and ventral buccal mucosal grafts

Study Type - Therapy (case series). Level of Evidence 4. What's known on the subject? and What does the study add? This technique has been reported to have an excellent success rate in the bulbar urethra, although no data exists for its use in the penile urethra. This is the first study to report successful use of the technique in the reconstruction of penile urethral strictures.

Objective: • To review our initial experience with single-stage overlapping dorsal and ventral buccal mucosa graft (BMG) urethroplasty for the reconstruction of complex anterior urethral strictures.

Patients and methods: • Among 696 urethroplasties performed at two tertiary urethroplasty centres from October 2007 to September 2010, single-stage urethral reconstruction using urethral plate incision and/or excision and overlapping dorsal and ventral BMGs was used in 36 men (5%) with complex urethral strictures (mean length 4.5 cm). • Demographic and perioperative data was tabulated and outcomes were analysed.

Results: • Stricture location was bulbar (61%), penile (19%), or both bulbar and penile (20%). • Dorsal grafts, applied only within the most severely strictured segment, measured a mean 42% of the opposing ventral graft length. • At a mean follow-up of 15.7 months, 32 of the 36 cases were successful (89%). • Repeat urethroplasty was performed in all four recurrences, three of which were successful at a mean follow-up of 16 months.

Conclusion: • Single-stage reconstruction of focally obliterative long urethral strictures using overlapping dorsal and ventral BMGs is safe and effective.