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Ventral onlay buccal mucosa urethroplasty: A 10‐year experience
Author(s) -
Mellon Matthew J,
Bihrle Richard
Publication year - 2014
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12236
Subject(s) - urethroplasty , medicine , urethral stricture , surgery , complication , meatal stenosis , buccal mucosa , buccal administration , stenosis , urethra , dentistry , oral cavity
Objective To report our experience, and to evaluate the long‐term outcomes and complication profiles of ventral onlay buccal mucosal graft urethroplasty ( BMU ) after prior urological intervention. Methods We retrospectively reviewed 114 consecutive patients between F ebruary 2001 and A pril 2009 who underwent buccal mucosal graft urethroplasty for recurrent anterior urethral stricture disease. Seven patients were excluded for incomplete data. The remaining 107 patients comprised the study cohort. The mean follow‐up time was 39.3 months (range 6.6–127.3 months). All patients had prior urological attempts at operative management. Results The mean stricture length was 3.14 cm (range 1.0–8.0 cm). Indications for buccal mucosal graft urethroplasty included: lichen sclerosis (2.8%), iatrogenic (24.3%), infection (4.7%) and perineal trauma/straddle injury (20.6%). Of these patients, 78 had bulbo‐membranous stricture disease, 20 had penile involvement and nine were multifocal strictures. The average number of prior urological procedures was 2.83 (range 1–9). The overall graft failure rate was 6.5%. Importantly, the re‐operation rate was 20.6%, primarily for stricture recurrence (18), meatal stenosis (3) and urethral diverticulum. The mean time to complication was 10.8 months. Conclusions Ventral onlay buccal mucosal graft urethroplasty offers satisfactory results in the setting of recurrent and complicated urethral stricture disease. Graft failures and complications generally occur within the first year after surgery. Bulbar strictures enjoy greater graft patency and lower complication rates than other stricture locations. In particular, guarded expectations should be given for stricture length >4 cm and multifocal disease.