Comparison between dorsal onlay and one-sided dorsolateral onlay buccal mucosal graft urethroplasty in long anterior urethral strictures

Objective: To compare dorsal onlay (conventional Barbagli) and one-sided dorsolateral onlay (Kulkarni technique) buccal mucosa substitution urethroplasty techniques for the treatment of long anterior urethral strictures.

Methods: Demographic data, treatment outcomes and success rates of patients who underwent either conventional Barbagli or Kulkarni urethroplasty for the treatment of an anterior urethral stricture longer than 8 cm between January 2010 and March 2019 in our center were retrospectively reviewed.

Results: Demographic parameters of patients who underwent the conventional Barbagli (n = 37) or Kulkarni procedure (n = 31) did not differ. The mean surgical duration and hospital stay were shorter for patients treated with the Kulkarni technique (179.5 ± 30.0 and 3.5 ± 1.2 vs 195.5 ± 28.9 min and 4.4 ± 1.8 days; P = 0.037, P = 0.002). Mean intraoperative blood loss and perioperative complication rates were signficantly lower in patients who underwent the Kulkarni technique than those who underwent the conventional Barbagli technique (164.3 ± 62.9 vs 202.4 ± 78.1 mL; P = 0.033 and 16.1% vs 37.8%; P = 0.046). The mean follow-up time period was 59.8 ± 24.7 and 63.5 ± 26.8 months for Kulkarni and conventional Barbagli techniques, respectively. Success rates based these follow-up time periods were 27 (87.1%) and 26 (70.3%) for the Kulkarni and conventional Barbagli techniques, respectively.

Conclusion: The Kulkarni technique should be more preferred for the treatment of long anterior urethral strictures over the conventional Barbagli technique based on surgical outcomes and success rates.