Management of recurrent anterior urethral strictures following buccal mucosal graft-urethroplasty: A single center experience

Abstract

Objective:To describe the safety, feasibility and outcome of redo buccal mucosal graft urethroplasty in patients presenting with recurrent anterior urethral stricture following previous failed BMG urethroplasty.Materials and Methods:This was a retrospective chart review of 21 patients with recurrent anterior urethral stricture after buccal mucosal graft urethroplasty, who underwent redo urethroplasty at our institute between January 2008 to January 2014. All patients underwent preoperative evaluation in the form of uroflowmetry, RGU, sonourethrogram and urethroscopy. Among patients with isolated bulbar urethral stricture, who had previously undergone ventral onlay, redo dorsal onlay BMG urethroplasty was done and vice versa (9+8 patients). Three patients, who had previously undergone Kulkarni-Barbagli urethroplasty, underwent dorsal free graft urethroplasty by ventral sagittal urethrotomy approach. One patient who had previously undergone urethroplasty by ASOPA technique underwent 2-stage Bracka repair. Catheter removal was done on 21st postoperative day. Follow-up consisted of uroflow, PVR and AUA-SS. Failure was defined as requirement of any post operative procedure.Results:Idiopathic urethral strictures constituted the predominant etiology. Eleven patients presented with stricture recurrence involving the entire grafted area, while the remaining 10 patients had fibrotic ring like strictures at the proximal/distal graft-urethral anastomotic sites. The success rate of redo surgery was 85.7% at a mean follow-up of 41.8 months (range: 1 yr-6 yrs). Among the 18 patients who required no intervention during the follow-up period, the graft survival was longer compared to their initial time to failure.Conclusion:Redo buccal mucosal graft urethroplasty is safe and feasible with good intermediate term outcomes.

Primary versus Redo Urethroplasty: Results from a Single-Center Comparative Analysis

“…As regards surgical outcome, SFS was significantly lower in the RU group compared to the PU group, which distinctly contradicts prior literature suggesting that primary and redo urethroplasties have an equivalent outcome in terms of SFS [7][8][9][10][11][12][13][14]. However, our findings actually do corroborate the results from Blaschko et al, who described the largest redo urethroplasty series so far [7].…”

“…ese failures may have been missed in their study as their mean follow-up was only 50 months [11]. Other researchers have investigated the redo urethroplasty setting as well, but their reports are characterized by a restricted sample size or a limited follow-up [9,[12][13][14]. Our patient series demonstrates that urethroplasty demands a prolonged follow-up since a significant amount of failures was observed after more than five years postoperatively, which is in line with the report from Han et al [6].…”

“…e aim of this study was to distinguish the primary and redo urethroplasty group and to compare the according SFS. Current literature shows similar success rates for primary and redo urethroplasty [7][8][9][10][11][12][13][14], although a majority of these papers indirectly compared the results of redo urethroplasty with success rates of primary procedures [8] or did not compare the results at all [7,9,[12][13][14]. Since patient and stricture characteristics, definitions of failure and follow-up protocols vary among different patient series, indirect comparison is hazardous and insufficient to draw adequate conclusions.…”

“…Be that as it may, the prognostic significance of prior urethroplasty remains highly controversial since several authors have published their experience with redo urethroplasty and reported success rates equivalent to primary urethroplasty [5,[7][8][9][10][11][12][13][14]. However, these reports contain several limitations and the different definitions of failure and different follow-up protocols make it hard to draw adequate conclusions [15].…”

A 10-year review of urethral stricture management in Irrua, Nigeria

“…The management begins with a good history. Affected men usually, in uncomplicated cases, present with lower urinary tract symptoms (LUTSs) while confirmation is with a retrograde urethrography,[ 8 ] sometimes in combination with micturating cystourethrography. The oldest known method of treatment is dilatation which is often palliative.…”