Bulbar Urethroplasty Using Buccal Mucosa Grafts Placed on the Ventral, Dorsal or Lateral Surface of the Urethra: Are Results Affected by the Surgical Technique?

Barbagli, Guido; Palminteri, Enzo; Guazzoni, G.; Montorsi, Francesco; Turini, Damiano; Lazzeri, Massimo

doi:10.1097/01.ju.0000169422.46721.d7

Cited by 245 publications

(176 citation statements)

References 13 publications

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“…The first was designed to look specifically at a comparison of dorsal versus ventral application of the BM graft . 7 The study included 50 patients, of whom 17 had the graft applied ventrally, 27 dorsally, and 6 laterally within the urethra. They reported a similar success rate of 83-85% in all groups.…”

Section: Dorsal Onlaymentioning

confidence: 99%

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Surgical Techniques in Substitution Urethroplasty Using Buccal Mucosa for the Treatment of Anterior Urethral Strictures

2008

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IntroductionSince the resurgence in the use of buccal mucosa in substitution urethroplasty in the late 1980s and early 1990s, there has been controversy as to which surgical technique is the most appropriate for its application. MethodThe authors performed a literature review. Several centres have published widely on this topic, and the points considered include the use buccal mucosa (BM) in dorsal-onlay grafts, ventral-onlay grafts, tubularised grafts and the role of two-stage procedures. ResultsIn experienced hands, the outcomes of both dorsal-onlay grafts and ventral-onlay grafts in bulbar urethroplasty are very similar. The dorsal-onlay technique is however possibly less dependent on surgical expertise and therefore more suitable for surgeons new to the practice of urethroplasty. The complications associated with ventral-onlay techniques can be minimised by meticulous surgical technique, but in series with longer follow-up still tend to be more prevalent.In penile urethroplasty, two-stage dorsal onlay of BM (after complete excision of the scarred urethra) still provides the best results, although in certain circumstances a onestage dorsal-onlay procedure is possible. In general, ventral-onlay of BM and tube graft procedures in the management of penile strictures are associated with much higher rates of recurrence and should therefore be avoided. ConclusionsIn experienced hands the results of the ventral and dorsal-onlay of BM for bulbar urethroplasty are equivalent. Two-stage procedures are preferable in the penile urethra, except under certain circumstances when one-stage dorsal-onlay is feasible.

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Section: Dorsal Onlaymentioning

confidence: 99%

“…7 With this in mind the authors performed a literature review to ascertain whether the updated literature was more indicative of which technique results in the best outcomes for BM urethroplasty, and should therefore for preference be used clinically.…”

mentioning

confidence: 99%

Surgical Techniques in Substitution Urethroplasty Using Buccal Mucosa for the Treatment of Anterior Urethral Strictures

2008

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“…Barbagli et al [9] found that all three sites were associated with similar outcomes. On review of literature it was found that both dorsal and ventral BMG augmentation urethroplasties were associated with similar outcomes (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…On review of literature it was found that both dorsal and ventral BMG augmentation urethroplasties were associated with similar outcomes (Table 2). [9][10][11][12] Proponents of dorsal placement of graft argue that there is decreased chance of diverticula formation and better chance of neovascularisation with the graft lying on cavernosal bodies which would not be seen if the graft is placed ventrally. The proponents of ventral placement in bulbar urethra argue that it offers better access to proximal site of stricture, less mobilization of urethra preserving its vascularity in addition to the fact that the bulbocavernous muscle prevents diverticula formation.…”

Section: Discussionmentioning

confidence: 99%

Does site of buccal mucosa graft for bulbar urethra stricture affect outcome? A comparative analysis of ventral, dorso-lateral and dorsal buccal mucosa graft augmentation urethroplasty

Pathak¹,

Jain²,

Bhujbal³

et al. 2017

Turkish Journal of Urology

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Objective: To compare long-term outcomes of buccal mucosa graft (BMG) augmentation urethroplasty for long segment bulbar urethral strictures done by placing the graft ventrally, dorso-laterally and dorsally. Material and methods:We conducted a single institution retrospective study on 112 who underwent BMG augmentation urethroplasty for non-traumatic bulbar urethral strictures between January 2005 to December 2014. The cases were divided into three groups based on the site of placement of BMG graft i.e. (a) Ventral (n=44), (b) Dorso-lateral (n=48) and (c) Dorsal (n=20). Follow-up period was from one year to five years. Patients with failed outcomes underwent urethroscopy or retrograde urethrogram to note the site of recurrence of stricture. Results:Out of 112 cases 91 (81%) were successful and 21 (19%) failed. The success rates for ventral, dorsolateral and dorsal BMG augmentation procedures were 89%, 79% and 70%, respectively (p= 0.18). Among 21 failed cases, 12 cases (57%) had stricture at proximal anastomotic site, 4 cases (19%) at graft and 5 cases (24%) at distal anastomotic site (p= 0.01). Conclusion:The overall success rate for BMG augmentation urethroplasty is equal for all techniques. Ventral onlay urethroplasty provides better exposure of proximal anastomotic site thus it is associated with minimum proximal anastomotic site recurrence rates. Patients with extensive spongiofibrosis and long segment strictures had higher rates of failure.

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“…In urethral stenosis treatment, it is important to take into account its localization, extension and degree of fibrosis of the corpus spongiosum (6). The endoscopic treatment of stenosis through the incision of the fibrotic tissue, with its posterior reepithelization, can be an option when the stenotic segment is short and has a limited degree of fibrosis (7).…”

Section: Introductionmentioning

confidence: 99%

Stereological and biochemical analysis of the urethral edges in patients submitted to end-to-end anastomosis for bulbar urethral stricture

et al. 2012

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ARTICLE INFO _________________________________________________________ ___________________Purpose: To study the morphologic alterations in the proximal and distal urethral edges from patients submitted to end-to-end bulbar urethroplasty. Materials and Methods:We analyzed 12 patients submitted to anastomotic urethroplasty to treat bulbar strictures less than 2.0 cm in length. After excision of the fibrotic segment to a 28Fr urethral caliber, we obtained biopsies from the spongious tissue of the free edges (proximal: PROX and distal: DIST). Controls included normal bulbar urethras obtained from autopsies of 10 age matched individuals. The samples were histologically processed for smooth muscle cells (SMC), elastic system fibers and collagen. Stereological analysis was performed to determine the volumetric density (Vv) of each element. Also, a biochemical analysis was performed to quantify the total collagen content. Results: Vv of SMC was reduced in PROX (31.48 ± 7.01 p < 0.05) and similar in DIST when compared to controls (55.65 ± 9.60%) with no statistical difference. Elastic fibers were increased in PROX (25.70 ± 3.21%; p < 0.05) and were similar to controls in DIST (15.87 ± 4.26%). Total collagen concentration in PROX (46.39 ± 8.20 µg/mg), and DIST (47.96 ± 9.42 µg/mg) did not differ from controls (48.85 ± 6.91 µg/mg). Type III collagen was similarly present in all samples. Conclusions: After excision of the stenotic segment to a caliber of 28Fr, the exposed and macroscopically normal urethral edges may present altered amounts of elastic fibers and SMC, but are free from fibrotic tissue. When excising the peri-stenotic tissue, the surgeon should be more careful in the proximal end, which is the most altered.

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Bulbar Urethroplasty Using Buccal Mucosa Grafts Placed on the Ventral, Dorsal or Lateral Surface of the Urethra: Are Results Affected by the Surgical Technique?

Cited by 245 publications

References 13 publications

Surgical Techniques in Substitution Urethroplasty Using Buccal Mucosa for the Treatment of Anterior Urethral Strictures

Surgical Techniques in Substitution Urethroplasty Using Buccal Mucosa for the Treatment of Anterior Urethral Strictures

Does site of buccal mucosa graft for bulbar urethra stricture affect outcome? A comparative analysis of ventral, dorso-lateral and dorsal buccal mucosa graft augmentation urethroplasty

Stereological and biochemical analysis of the urethral edges in patients submitted to end-to-end anastomosis for bulbar urethral stricture

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