Buccal mucosal graft substitution urethroplasty of posterior penile and bulbar urethra
Authors:
Tomáš Ürge; Olga Dolejšová; Jiří Kouba; Milan Hora
Authors place of work:
Urologická klinika FN Plzeň
Published in the journal:
Ces Urol 2022; 26(3): 193-201
Category:
Original Articles
Summary
Introduction: We started using buccal mucosal graft in November 2019 to treat recurrent strictures of the urethra outside the anastomosis area in patients after laparoscopic radical prostatectomy (LRP) and subsequently also performed it for strictures from other causes.
Group: The group includes 14 men aged 66.7 ± 6.8 years who had recurrent stricture of the posterior penile to bulbar Jordan D urethra 18–73 mm (diameter 25 mm) according to urethrography. The cause of the stricture was instrumentation in the urethra in 11/14 (78%) patients. In one patient, the cause was an allergic reaction to the catheter material, another was after chlamydial urethritis, and the last one had a traumatic stricture after a fall and blunt trauma to the perineum more than 10 years ago.
Material and methods: The intraoperative length of the stricture (necessary length of the graft) was approximately 25–140 mm, an average of 50 mm. The procedure was 163 ± 29 minutes long. Patients were discharged on the 3rd–5th postoperative day. Postoperative complications were noted in only one patient. It was a fistula in the penoscrotal angle, which healed after the establishment of an epicystostomy and the subsequent stricture of the urethra at the site of the Jordan B fistula, which was solved by an endoscopic incision followed by regular selfdilatation.
Results: Patients were monitored 5–28 months after the procedure, urine without residues, Qmax on UFM is on average 14 ± 4 ml/s (Qaverage 10 ± 3 ml/s). All patients evaluated the procedure positively, no one suffered for urinary infection or urinary retention. Four patients (previously after LRP) have grade I-II stress incontinence.
Conclusion: In conclusion, urethroplasty using a graft from the buccal mucosa is an option to treat urethral stricture in patients with severe spongiofibrosis. The published results are encouraging, but we are aware of the limits of the work, due to the short follow-up period.
Keywords:
reconstructive surgical procedures – Urethral stricture – mouth mucosa
Zdroje
1. Pansadoro V, Emiliozzi P, Gaffi M, Scarpone P. Buccal mucosa urethroplasty for the treatment of bulbar urethral strictures. J Urol. 1999; 161(5): 1501–3.
2. Fiala R, Záťura F, Reif R. Striktura a trauma mužské uretry. Praha: StudiaGeo 1999, edice UROLOG: 74–77.
3. Andrich DE, Mundy AR. What is the best technique for urethroplasty? Eur Urol. 2008; 54(5): 1031–41.
4. Humby GA. A one‑stage operation for hypospadias. Br J Surg. 1941; 29: 84–92.
5. Barbagli G, Palminteri E, Rizzo M. Dorsal onlay graft urethroplasty using penile skin or buccal mucosa in adult bulbourethral strictures. J Urol. 1998; 160(4): 1307–1309.
6. Bhargava S, Chapple CR. Buccal mucosal urethroplasty: is it the new gold standard? BJU‑Int. 2004; 93: 1191–1193.
7. Barbagli G, Palminteri E, Guazzoni G, et al. Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique? J. Urol. 2005; 174: 955–957.
8. Raber M, Naspro R, Scapaticci E, et al. Dorsal onlay graft urethroplasty using penile skin or buccal mucosa for repair of bulbar urethral stricture: results of a prospective single center study. Eur. Urol. 2005; 48: 1013–1017.
9. Dubey D, Kumar A, Mandhani A, et al. Buccal mucosal urethroplasty: a versatile technique for all urethral segments. BJU‑Int. 2005; 95: 625–629.
10. Barbagli G, Palminteri E, Guazzoni G, et al. Urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique? J Urol. 2005; 174(3): 955–7; discussion 957–8.
11. Asopa HS, Garg M, Singhal GG, et al. Dorsal freegraft urethroplasty for urethral stricture by ventral sagittal urethrotomy approach. Urology. 2001; 58: 657–659.
12. Prabha V, Devaraju S, Vernekar R, Hiremath M. Single stage: dorsolateral onlay buccal mucosal urethroplasty for long anterior urethral strictures using perineal route. Int Braz J Urol. 2016; 42(3): 564–70.
13. Morey AF, McAninch JW. When and how to use buccal mucosal grafts in adult bulbar urethroplasty. Urology. 1996; 48: 194–8.
14. Horiguchi A. Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews. Int J Urol. 2017; 24(7): 493–503.
15. Kulkarni SB, Joshi PM, Venkatesan K. Management of panurethral stricture disease in India. J. Urol. 2012; 188: 824–30.
16. Guralnick ML, Webster GD. The augmented anastomotic urethroplasty: indications and outcome in 29 patients. J. Urol. 2001; 165: 1496–501.
17. Barbagli G, De Angelis M, Romano G, Lazzeri M. Long‑term followup of bulbar end‑to‑end anastomosis: a retrospective analysis of 153 patients in a single center experience. J. Urol. 2007; 178: 2470–3.
18. Palminteri E, Berdondini E, Shokeir AA, et. al. Two‑sided bulbar urethroplasty using dorsal plus ventral oral graft: urinary and sexual outcomes of a new technique. J. Urol. 2011; 185: 1766–71. Soutěž
Štítky
Paediatric urologist Nephrology UrologyČlánok vyšiel v časopise
Czech Urology
2022 Číslo 3
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