Dorsal Onlay Buccal Mucosal Graft Urethroplasty in the Treatment of Urethral Strictures – Does the Stricture Length Affect Success?

Abstract

Background. Treatment of urethral strictures can be challenging, but, with appropriate preoperative evaluation and surgical planning it is possible to achieve successful results. Objectives. To analyze if the stricture length affects the success with dorsal onlay buccal mucosal graft urethroplasty technique. Material and Methods. Between January 2004 and June 2010 a total of 40 patients with anterior urethral stricture were treated with dorsal onlay buccal mucosal graft urethroplasty. Age, etiology of the stricture, stricture length (≤ 7 cm, and > 7 cm), and localization of the stricture were assessed as the factors affecting success rate. Results. The clinical outcome was defined as a failure when any operative instrumentation including dilatation was needed or the urine flow rate was less than 14 mL per second at the sixth month, postoperatively. The mean follow-up period was 43.44 months. Of 40 patients, 28 (70%) were successful and 12 (30%) were a failure. There was no statistically significant difference between the age groups, etiology of the stricture and success rate (p = 0.26 and p = 0.41). The statistical difference was significant for the localization and length of the stricture by means of success (p = 0.002 and p = 0.025). Conclusions. Our results show that the stricture length and localization are the most important variables for desirable success. Even though surgical techniques are constantly evolving, long strictures stay as a problem for urologists. Studies with larger number of patients with long urethral strictures may support our findings, and may prove the efficiency of these surgical techniques (Adv Clin Exp Med 2015, 24, 2, 297-300).

Results of Use of Tissue-Engineered Autologous Oral Mucosa Graft for Urethral Reconstruction: A Multicenter, Prospective, Observational Trial

“…A recent meta-analysis of 10 cohort studies of buccal mucosa graft urethroplasty and end-to-end anastomosis in short segment bulbar urethral stricture reported a recurrence rate of 30% ( Yuri et al, 2016 ). The current survey, evaluated by an independent CRO, included complex penile and longer strictures ( Liu et al, 2016 , Ortega and Pena, 2009 , Bello, 2016 , Breyer et al, 2010 , Yalcinkaya et al, 2015 ), and excluded end-to end anastomosis (known to have a very high SR) ( Ortega and Pena, 2009 , Ivaz et al, 2017 ). One can therefore consider the results of our study in general accordance with buccal mucosa urethroplasty ( Yuri et al, 2016 , Chauhan et al, 2016 ).…”

Everted saphenous vein graft for long anterior urethral strictures in men with tobacco-exposed oral mucosa: A prospective nonrandomized study

“…[ 14 ] in their study in 40 patients with anterior urethral stricture treated with dorsal onlay BMG urethroplasty suggested that stricture length and localization are the most important variables for desirable success and also reported 82% success rate for patients with stricture length >4 cm and 76% for stricture length ≥6 cm. According to Yalcinkaya et al .,[ 2 ] length of stricture dramatically and statistically affects the outcomes of urethroplasty, and using BMG, they also reported 88% success rate for stricture length ≤7 cm and only 40% success rate for stricture length >7 cm.…”

“…Oral mucosa graft (OMG) is the graft of choice for all urethral substitutions and has been considered as the gold standard graft. Recently, concerns have been raised about the factors responsible for poorer outcomes after buccal graft anterior urethroplasty which include long-segment urethral strictures[ 1 2 ] and tobacco-exposed oral mucosa. [ 3 ] There is thus a need to search for alternate grafts for substitution in such scenario.…”

Looking beyond oral mucosa: Initial results of everted saphenous vein graft urethroplasty (eSVGU) in long anterior urethral strictures

“…OMGs have poorer overall success rates and inconsistent results in long anterior urethral strictures. Success rates of OMG urethroplasty in strictures of >7 cm is almost half that of those <7 cm (40% vs 88%) [3] . Chauhan et al [5] compared the success of BMG with a lingual mucosal graft in long urethral stricture patients (range 3.2–13.4 cm) and found the stricture length was the significant predictor of success and success was higher in shorter strictures on univariate analysis.…”

“…OMGs have continued to give reliable and reproducible results in past two decades and have virtually become the ‘one-stop shop’ for all urethral reconstructive needs. However, recent literature has highlighted some concerns in the use of OMG in certain subsets of patients, namely those with tobacco-exposed oral mucosa [2] and those with pan-anterior strictures [3] that necessitate looking beyond the oral mucosa.…”