URETHROPLASTY USING BUCCAL MUCOSA FOR TREATMENT OF ANTERIOR URETHRAL STRICTURE

Abstract

Background: For the second half of the 20th century, the urethral reconstruction pendulum has swung from mainly two stage urethroplasty, then to grafts, then onto fasciocutaneous flaps, and currently, has swung back to grafts (buccal mucosa). Great promise lies with tissue engineering and regenerative medicine today. BMG is advantageous because it is associated with little donor site morbidity and it appears to resist infection well. Aim of the work: To evaluate the results of buccal mucosa graft urethroplasty in repair of anterior urethral stricture. Patients and methods: Between July 2009 and June 2012, 30 patients with anterior urethral stricture and stricture length < 2cm were operated as one stage ventral onlay buccal mucosa graft (BMG) urethroplasty. Posterior urethral stricture, active UTI and VIU or urethroplasty within the last 3 months were the exclusion criteria. All patients were subjected to complete urological and oral evaluation preoperatively. Ascending urethrography and micturating cystourethrography were done for all patients. Uro-flowmetry was done as a base line for follow-up. The study population was divided into 3 groups (penile, bulbar and peno-bulbar) according to the actual intra-operative stricture site. The graft was tailored according to site, length, and stricture characteristics and sutured to the edges of the opened urethra. The donor site was followed-up for oral bleeding, hematoma, cheek swelling and perioral numbness in the first week and after one month. The urethroplasty wound was followed-up for post-operative bleeding or infection. Whenever obstructive symptoms were met or maximum flow rate deteriorated to < 14 ml/sec, urethrography was done. Successful reconstruction was equal to normal voiding without need for any postoperative procedures including dilatation. Results: Of all patients, 66.67 % of the patients had stricture length ≤ 5 cm while 33.33 % of the patients had stricture length < 5 cm. The overall success rate was 83.33% at the end of the study. The success rates were 85.71%, 80% and 84.62% for penile, bulbar and peno-bulbar urethroplasty groups respectively. Out of the 5 patients who developed re-stricture during follow-up, 4 patients with initial stricture length < 5 cm had re-stricture at the proximal anastomotic site. The stricture length had a significant effect on the success rate, with strictures ≤ 5 cm having a better prognosis (P value = 0.0192). Conclusion: Buccal mucosa is an excellent graft for repairing anterior urethra stricture with minimal donor and recipient site complications. A ventrally placed buccal mucosa graft has the advantages of ease of stricture exposure, ideal richly vascularized graft bed and excellent long-term stricture-free rates.
Key words: buccal mucosa – graft - urethral stricture - urethroplasty.