Dorsal versus ventral onlay buccal mucosal graft urethroplasty for long‐segment bulbar urethral stricture: A prospective randomized study

Abstract

Objectives: To compare safety and efficacy of ventral versus dorsal onlay buccal mucosal graft urethroplasty in patients with long-segment incomplete bulbar urethral stricture.Methods: This was a single center, prospective, randomized trial. Patients with longsegment (>2 cm) incomplete bulbar urethral stricture and meeting eligibility criteria were enrolled in the study. They were randomized into two study groups: group A undergoing dorsal onlay buccal mucosal graft urethroplasty and group B undergoing ventral onlay buccal mucosal graft urethroplasty. The two groups were compared statistically with regard to International Prostate Symptom Score, maximum flow rate, intraoperative parameters and complications. Results: A total of 80 eligible patients were randomized into two equal groups of 40 patients each. The preoperative International Prostate Symptom Score, maximum flow rate and intraoperative parameters were not significantly different between the two groups. At 12-month follow up, the mean International Prostate Symptom Score showed 324.95% and 353.59% improvement, whereas the mean maximum flow rate showed 208.43% and 201.93% improvement in group A and B, respectively. There was no significant difference between International Prostate Symptom Score and maximum flow rate data between the two groups at 3-and 12-month follow up. The success rate of surgery was similar between group A and B (92.5% vs 90%) with no significant difference noted between them. Conclusion: Dorsal and ventral onlay buccal mucosal graft urethroplasty have comparable efficacy and complication rates for treatment of long-segment incomplete bulbar urethral strictures.

Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews

“…Ventral and dorsal onlay urethroplasties are the most popular types of substitution urethroplasty, and the different graft positions (ventral or dorsal) have shown no difference in success rate in bulbar urethroplasty. 43,44 When a bulbar urethral stricture has an obliterative or nearly obliterative segment, neither EPA nor an onlay procedure is possible, because such a stricture contains a significant amount of spongiofibrosis that would potentially risk the success of the graft or flap, and because the length of excised urethra would result in too much tension on anastomosis. One solution for this kind of stricture is a combination of EPA and primary anastomosis and onlay augmentation, a combination called an augmented anastomotic urethroplasty.…”

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

“…Vasudeva et al [12] 92.5% (n=40) ------90% (n=40) ly rather than dorsally and even dorso-laterally. This was especially true when the stricture was localized more proximally in bulbar urethra and the spatulation displaced the anastomotic site more proximally.…”

“…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.…”

Urethral Balloon Dilatation: Factors Affecting Outcomes

“…Most urologists believe the concept of ‘reconstructive ladder', the basic tenet of which entails resorting to the minimally invasive surgeries namely Balloon dilation or VIU and resorting to a formal urethroplasty as the last resort [6]. The variants of the latter could include an end-to-end or substitution/augmentation urethroplasty, depending on the length and site of stricture [7]. The need for general anesthesia, prolonged surgery and hospital stay, longer catheterization, necessary surgical expertise and patient selection are pitfalls of the procedure.…”