Glans Preservation in Surgical Treatment of Distal Urethral Strictures With Dorsal Buccal Mucosa Graft Onlay by Subcoronal Approach

Favre, G.; Villa, Sergio Gil; Scherñuk, Jordán; Tobía, Ignacio; Giúdice, Carlos

doi:10.1016/j.urology.2020.12.014

Cited by 9 publications

(5 citation statements)

References 23 publications

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“…Numerous techniques involve placing the free graft ventrally or dorsally, either as an onlay or inlay, to augment the urethral plate. [ 3 4 5 6 ] In this approach, we opted for a dorsal inlay placement of the free graft because of adequate availability of space on the dorsal aspect and the presence of a vascularized bed for graft support and fixation.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 2 ] Various surgical techniques have been described for the management of meatal stenosis and FNS, wherein the reconstruction of the urethral lumen is performed with a free graft or local vascularized flap using either inlay or onlay techniques. [ 2 3 4 5 6 ] The most commonly utilized tissues for augmenting the urethral plate include the oral mucosa graft (OMG) and inner preputial free graft (IPG). [ 3 4 6 ] The primary goals of treatment of FNS include alleviating the bothersome symptoms, ensuring unobstructed urine flow, and achieving cosmetically pleasing glans.…”

Section: Introductionmentioning

confidence: 99%

“…[ 2 3 4 5 6 ] The most commonly utilized tissues for augmenting the urethral plate include the oral mucosa graft (OMG) and inner preputial free graft (IPG). [ 3 4 6 ] The primary goals of treatment of FNS include alleviating the bothersome symptoms, ensuring unobstructed urine flow, and achieving cosmetically pleasing glans. However, the technical challenge lies in enhancing the caliber of the urethral lumen without altering the contour of the glans.…”

Section: Introductionmentioning

confidence: 99%

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Glans cap-preserving dorsal inlay-free graft augmentation technique for reconstruction of meatal stenosis and fossa navicularis strictures: Analysis of short-term functional outcomes

Enganti,

Nanavati,

Madduri

et al. 2024

Indian Journal of Urology

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Introduction: Meatal stenosis and fossa navicularis strictures (FNSs) are commonly caused by lichen sclerosus and instrumentation. We present the technique and short-term functional outcomes of glans cap-preserving dorsal inlay-free graft augmentation for the reconstruction of meatal stenosis and FNS. Methods: This retrospective study analyzed patients with meatal stenosis and FNS who underwent glans cap-preserving dorsal inlay-free graft augmentation at our institute since 2019. The surgical technique included a ventral subcoronal approach, preservation and mobilization of the glans cap, a ventral midline urethrotomy incision over the stricture, and a dorsal midline meatotomy incision extending to the proximal normal urethral mucosa at the fossa navicularis, followed by dorsal inlay graft augmentation. During the follow-up, patients were periodically assessed for symptom scores, urinary flow rates (UFRs), and patient-reported outcomes. Results: A total of 26 patients with a mean age of 45 ± 15 years were assessed. The predominant cause of stricture was lichen sclerosus (n = 15; 58%). The mean stricture length was 3.8 ± 0.5 cm, 73% had a circumcised phallus, and an oral mucosa graft augmentation was performed in 22 (85%) patients. Notable postoperative complications included intractable meatal hemorrhage (n = 1) and glans suture granuloma (n = 1), which required intervention. At a mean follow-up of 40 months, there were four failures, of which one patient required redo-urethroplasty. The remaining patients (n = 22; 85%) showed improved symptom scores (P < 0.05), UFRs (P < 0.05), and satisfactory patient-reported outcomes. Conclusion: Glans cap-preserving dorsal inlay-free graft augmentation is a safe and feasible technique with satisfactory short-term functional outcomes for the management of meatal stenosis and FNS in carefully selected patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Glans cap-preserving dorsal inlay-free graft augmentation technique for reconstruction of meatal stenosis and fossa navicularis strictures: Analysis of short-term functional outcomes

Enganti,

Nanavati,

Madduri

et al. 2024

Indian Journal of Urology

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“…7 Lichen sclerosus et atroficus as a frequent cause of the disease limits the use of genital skin and promotes the use of buccal mucosa grafts. 1,8 More transurethral approaches to urethroplasty are used in an effort to avoid skin incisions and minimize urethral dissection but are limited to short strictures. 9 The risk of incomplete exposure of healthy proximal mucosa for good anastomoses exists.…”

Section: Discussionmentioning

confidence: 99%

“…When distal urethral strictures involve the FN (distal urethral stricture (DUS)+FN), the repair entails not only achieving long-term urethral patency but also cosmetic results. 1,2 The treatment of penile and distal urethral strictures including the FN and the meatus remains challenging. Direct vision internal urethrotomy is not advised for penile strictures and urethroplasty is associated with significantly better long-term success rates.…”

Section: Introductionmentioning

confidence: 99%

Glans Preserving Buccal Mucosa Urethroplasty for Glandular and Distal Urethral Strictures

Laet¹,

Win²

2022

Turkish Journal of Urology

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Background: To describe a step-by-step approach for glans preserving urethroplasty with a dorsal inlay graft used for distal urethral strictures. Description of the Technique:The reconstruction was performed through a keyhole incision in the urethra. In this way, we achieve maximal exposure by a minimal incision and saving of the glans. After incision of the diseased dorsal urethral mucosa through the keyhole and the meatus, a buccal mucosa graft pull-through resulting in a dorsal inlay is done. Patient(s) and Methods:We treated 10 patients in different clinical settings with success by using the newly described technique below. We highlight and illustrate 1 case of a 34-year-circumcised male. Antegrade urethrogram showed a distal penile and fossa navicularis stricture with a total estimated length of 3.5 cm. Results:In this specific case the glans sparing approach had a surgical duration of 115 minutes. After 3 weeks the urinary catheter was removed. At 12 months, the patient reported no remaining urinary tract symptoms. Examination showed a fully healed lesion and an adequate uroflowmetry with a Q max of 24 mL/s coming from 4 mL/s pre-operatively. In our 10-patient case series, all treated patients had complete resolution of their complaints, significant improvement in flow rates and excellent cosmetic results without complications. Conclusion:In selected cases, the described technique is feasible, safe, and effective with excellent functional outcomes and better cosmetic results especially due to the glans preservation.

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Transurethral reconstruction of fossa navicularis strictures with dorsal inlay buccal mucosa graft urethroplasty

et al. 2022

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Glans Preservation in Surgical Treatment of Distal Urethral Strictures With Dorsal Buccal Mucosa Graft Onlay by Subcoronal Approach

Cited by 9 publications

References 23 publications

Glans cap-preserving dorsal inlay-free graft augmentation technique for reconstruction of meatal stenosis and fossa navicularis strictures: Analysis of short-term functional outcomes

Glans cap-preserving dorsal inlay-free graft augmentation technique for reconstruction of meatal stenosis and fossa navicularis strictures: Analysis of short-term functional outcomes

Glans Preserving Buccal Mucosa Urethroplasty for Glandular and Distal Urethral Strictures

Transurethral reconstruction of fossa navicularis strictures with dorsal inlay buccal mucosa graft urethroplasty

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