Premium
Single‐stage segmental urethral replacement using combined ventral onlay fasciocutaneous flap with dorsal onlay buccal grafting for long segment strictures
Author(s) -
Erickson Bradley A.,
Breyer Benjamin N.,
McAninch Jack W.
Publication year - 2012
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2011.10483.x
Subject(s) - urethroplasty , medicine , surgery , single stage , stage (stratigraphy) , urethral stricture , urethra , urinary diversion , dorsum , buccal mucosa , buccal administration , dentistry , anatomy , paleontology , oral cavity , bladder cancer , cystectomy , engineering , biology , aerospace engineering , cancer
Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Single‐stage urethral segment replacement has historically poor outcomes and two‐stage repairs are now more common. We present a novel approach to the single‐stage repair with initial outcomes similar to two‐stage repairs. OBJECTIVE• To present our experience with repairing long‐segment urethralstrictures in a single‐stage using a combined tissue‐transfer technique.PATIENTS AND METHODS• In all, 14 men underwent urethroplasty where a segment of urethra was completely replaced using a dorsal onlay buccal mucosa graft and a ventral onlay fasciocutaneous flap in a singlestage. • Primary success was defined as an open urethra at >6 months follow‐up with no need for additional surgical intervention. • Secondary success was defined as the need for a single postoperative endoscopic procedure before stricture stabilization. • Failure was the need for multiple endoscopic procedures, repeat urethroplasty, urinary diversion or intermittent dilatation.RESULTS• The mean ( sd ) stricture length was 9.75 (4.6) cm. The mean ( sd ) neourethral length was 5.4 (2.7) cm. Stricture location was penile/bulbar in 12men, and bulbar alone in two. Primary success was achieved in nine of the 14 men at a median (range) follow‐up of 2.5 (0.5–9.43) years. • The mean ( sd ) time to recurrence in the five initial failures was 340 (376) days. • Secondary success was achieved in two men after a single endoscopic procedure for an overall success in 11 of 14 men. • Patients that recurred had longer strictures (12.8 vs 8.7 cm, P = 0.04) than initial successes, but neourethral lengths were similar (6.2 vs 5.1 cm, P = 0.5). • In all, three of the 14 men failed, two of whom required a repeat urethroplasty.CONCLUSIONS• Our initial outcomes were favourable using the combined tissue‐transfer technique for segmental urethral replacement with initial and secondary success rates similar to those reported for two‐stage repairs. • This technique is not suitable for all patients as it requires healthy penile skin, but appears to be effective when a single‐stage repair is desirable.