Comparison between dorsal onlay and one‐sided dorsolateral onlay buccal mucosal graft urethroplasty in long anterior urethral strictures

Abstract

Objective To compare dorsal onlay (conventional Barbagli) and one‐sided dorsolateral onlay (Kulkarni technique) buccal mucosa substitution urethroplasty techniques for the treatment of long anterior urethral strictures. Methods Demographic data, treatment outcomes and success rates of patients who underwent either conventional Barbagli or Kulkarni urethroplasty for the treatment of an anterior urethral stricture longer than 8 cm between January 2010 and March 2019 in our center were retrospectively reviewed. Results Demographic parameters of patients who underwent the conventional Barbagli (n = 37) or Kulkarni procedure (n = 31) did not differ. The mean surgical duration and hospital stay were shorter for patients treated with the Kulkarni technique (179.5 ± 30.0 and 3.5 ± 1.2 vs 195.5 ± 28.9 min and 4.4 ± 1.8 days; P = 0.037, P = 0.002). Mean intraoperative blood loss and perioperative complication rates were signficantly lower in patients who underwent the Kulkarni technique than those who underwent the conventional Barbagli technique (164.3 ± 62.9 vs 202.4 ± 78.1 mL; P = 0.033 and 16.1% vs 37.8%; P = 0.046). The mean follow‐up time period was 59.8 ± 24.7 and 63.5 ± 26.8 months for Kulkarni and conventional Barbagli techniques, respectively. Success rates based these follow‐up time periods were 27 (87.1%) and 26 (70.3%) for the Kulkarni and conventional Barbagli techniques, respectively. Conclusion The Kulkarni technique should be more preferred for the treatment of long anterior urethral strictures over the conventional Barbagli technique based on surgical outcomes and success rates.

Dorsal Onlay Urethroplasty Using Buccal Mucosal Graft and Vaginal Wall Graft for Female Urethral Stricture; Outcome of a Tertiary Care Hospital

“…The buccal mucosal grafting is advantageous over VWG due to the narrowing of the vagina, but VWG has the advantage in case of patients having unhygienic conditions, smoking, and some oral infections. In the case of VWG, local anesthesia was given to the patients, but in some cases, general anesthesia also needed to be utilized [21][22] .…”

Intraoperative cell salvage transfusion in patients undergoing posterior urethroplasty: Its efficacy of reducing allogeneic blood transfusion, safety, and cost

“…Urethroplasty using buccal mucosa for long anterior urethral stricture in one series ranged between 164 and 202 ml blood loss and 133 and 108 ml in another. [ 26 27 ] The rate of ABT in perineal urethroplasty is not high, but it cannot be predicted preoperatively because of altered anatomy due to traumatic injury. Our study has not used even a single unit of allogeneic blood intraoperatively, and two patients who bled profusely required ABT postoperatively.…”

Editorial Comment to Comparison between dorsal onlay and one‐sided dorsolateral onlay buccal mucosal graft urethroplasty in long anterior urethral strictures

“…Kartal et al retrospectively compared the surgical outcome between dorsal and dorsolateral onlay carried out in a single institution. 3 They concluded that dorsolateral onlay was preferred in terms of surgical outcomes and success rates, possibly due to preserved blood supply. However, the type of urethroplasty was not randomized, but selected by the surgeon based on the stricture characteristics.…”