Abstract

European Urology 53 (2008) 81-90 – Surgery in Motion

Objectives:
We describe a technique for bulbar urethral reconstruction using a combined dorsal plus ventral double buccal mucosa graft (BMG).
Methods:
From March 2002 to June 2006, 48 men (mean age 35years) with bulbar strictures underwent patch urethroplasty using a dorsal plus a ventral double BMG. Average stricture length was 3.65 cm (range 2 to 10). The stenotic urethral segment was opened along its ventral surface; the exposed dorsal urethra was incised in the midline to create an elliptical area over the tunica albuginea where the dorsal-inlay BMG was placed and quilted to the corpora to augment dorsally the urethral plate. Subsequently, the ventral-onlay BMG was sutured to the urethral lateral margins to complete the augmented urethroplasty. Finally, the spongiosum was closed over the graft. Successful reconstruction was defined as normal voiding without need for any postoperative procedure including dilation.
Results:
Mean follow up was 22 months (range 13 to 59). At the catheter removal 3 weeks after surgery, in 3 patients the voiding cystourethrography showed a fistula which recovered by a prolonged catheterization. Of 48 cases 43 (89.6 %) were successful and 5 (10.4 %) failures with recurrence of the stricture: 4 were treated with internal urethrotomy and 1 with a temporary perineal urethrostomy.
Conclusions:
Preliminary results with a combined double BMG urethroplasty for severe bulbar stricture are encouraging. The double dorsal and ventral graft may provide a simple and reliable solution to achieve an adequate urethral lumen in selected patients.