ObjectiveOur study aimed to compare surgical success rate (SR) and oral morbidity of augmentation urethroplasty for anterior urethral strictures using autologous tissue‐engineered oral mucosa graft (TEOMG) named MukoCell® versus native oral mucosa graft (NOMG).MethodsWe conducted a single‐institution observational study on patients undergoing TEOMG and NOMG urethroplasty for anterior urethral strictures >2 cm in length from January 2016 to July 2020. SR, oral morbidity, and potential risk factors of recurrence were compared between groups were analyzed. A decrease of maximum uroflow rate < 15 mL/s or further instrumentation was considered a failure.ResultsOverall, TEOMG (n = 77) and NOMG (n = 76) groups had comparable SR (68.8% vs. 78.9%, p = 0.155) after a median follow‐up of 52 (interquartile range [IQR] 45–60) months for TEOMG and 53.5 (IQR 43–58) months for NOMG. Subgroup analysis revealed comparable SR according to surgical technique, stricture localization, and length. Only following repetitive urethral dilatations, TEOMG achieved lower SR (31.3% vs. 81.3%, p = 0.003). Surgical time was significantly shorter by TEOMG use (median 104 vs. 182 min, p < 0.001). Oral morbidity and the associated “burden” in patients' quality of life were significantly less at 3 weeks following the biopsy required for TEOMG manufacture, compared to NOMG harvesting and totally absent at 6 and 12 months postoperatively.ConclusionsThe SR of TEOMG urethroplasty appeared to be comparable to NOMG at a mid‐term follow‐up but taking into account the uneven distribution of stricture site and the surgical techniques used in both groups. Surgical time was significantly shortened, since no intraoperative mucosa harvesting was required, and oral complications were diminished through the preoperative biopsy for MukoCell® manufacture.

Staged urethroplasty is performed to treat long-segment obliterating anterior urethral strictures. The technique is particularly challenging when the penobulbar junction is involved, as it requires the transection of the scrotum and the formation of lateral testicular fans. To date, there is no established surgical protocol for this ancillary technique in large volume scrotums with excess skin. We report a case of staged urethroplasty with the necessity of performing T-scrotoplasty due to bulky scrotum. After six months, the Tplasty was successfully resolved, and a new scrotum was formed from the two hemiscrota. In conclusion, scrotoplasty using a bilateral T-plasty is an excellent technique to overcome the necessity of splitting the scrotum by externalizing the urethra to allow for excellent buccal mucosal graft healing over a period of six months. The two separate testicular fans can be reapproximated along the raphe after re-tubularizing the urethra in the 2nd stage, shaping a new scrotum with satisfactory cosmetic results.

Consequently, irrigation of the spongiosum will depend on the dorsal penile arteries and retrograde flow from the glans. However, if the penile arterial blood supply is compromised, transection may result in ischemia of the bulb and failure of the reconstruction. To decrease this risk, we modified the EPA technique avoiding urethral transection to preserve the bulbar arteries. We report our long-term results with this vesselsparing posterior EPA approach (vspEPA).METHODS: Surgical Technique. The bulbar urethra is mobilized in a non-transecting fashion by division of the triangular ligament without detachment of the bulb from the perineal body. Distal release and lateral retraction of the bulbar urethra to one side with two vessel loops provides sufficient room for scar removal and anastomosis as with the classic transecting technique. In most cases both bulbar arteries can be spared, but in front of severe local fibrosis, division of one artery may be necessary to remove the scar, preserving the contralateral artery.RESULTS: Since April 2008, 115 patients with PUS received a vspEPA at our institution. The patients had a bulbo-membranous stenosis (n[91, 79%), prostate-membranous stenosis (n[11, 10%), or bulbo-vesical stenosis (n[13, 11%). Median age was 60 years (range 15-83) and median stenosis length was 2.5 cm (range 1-6), Sixty-two patients (54%) had a complete urethral obliteration. Bulbar artery preservation was unilateral in 57 and bilateral in 58. Median operative time was 170 min (range 70-265) and median estimated blood loss was 300 cc (range 50-2,000). A bulbo-membranous anastomosis was performed in 48 patients (42%), bulbo-prostatic in 54 (47%) and bulbo-vesical in 13 (11%). With 47 months of median follow up (range 5-146), vspEPA was successful in 109 patients (95%). Complications occurred in 34 (30%) patients but only 6 (5%) of them were Clavien grade !III.CONCLUSIONS: This vspEPA technique is feasible and safe and since 2008 it is our standard approach for anastomotic urethroplasty at the posterior urethra. We believe that vascular preservation may improve the outcome of reconstruction and our results are meaningful and highly encouraging.