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

Abstract

Male anterior urethral stricture is scarring of the subepithelial tissue of the corpus spongiosum that constricts the urethral lumen, decreasing the urinary stream. Its surgical management is a challenging problem, and has changed dramatically in the past several decades. Open surgical repair using grafts or flaps, called substitution urethroplasty, has become the gold standard procedure for anterior urethral strictures that are not amenable to excision and primary anastomosis. Oral mucosa harvested from the inner cheek (buccal mucosa) is an ideal material, and is most commonly used for substitution urethroplasty, and lingual mucosa harvested from the underside of the tongue has recently emerged as an alternative material with equivalent outcome. Onlay augmentation of oral mucosa graft on the ventral side (ventral onlay) or dorsal side (dorsal onlay, Barbagli procedure) has been widely used for bulbar urethral stricture with comparable success rates. In bulbar urethral strictures containing obliterative or nearly obliterative segments, either a two-sided dorsal plus ventral onlay (Palminteri technique) or a combination of excision and primary anastomosis and onlay augmentation (augmented anastomotic urethroplasty) are the procedures of choice. Most penile urethral strictures can be repaired in a one-stage procedure either by dorsal inlay with ventral sagittal urethrotomy (Asopa technique) or dorsolateral onlay with one-sided urethral dissection (Kulkarni technique); however, staged urethroplasty remains the procedure of choice for complex strictures, including strictures associated with genital lichen sclerosus or failed hypospadias. This article presents an overview of substitution urethroplasty using oral mucosa graft, and reviews current topics.

Editorial Comment to Dorsal onlay urethroplasty using lingual mucosal grafts for lichen sclerosis anterior urethral strictures repair: Long‐term outcomes

“…3 My opinion is that lingual mucosa is better in patients with a short stricture requiring only a small amount of graft, in patients with a lengthy stricture requiring additional tissue grafts other than buccal mucosa and in patients undergoing salvage urethroplasty whose buccal mucosa has already been bilaterally harvested. 4 In contrast to my opinion, Aldaqadossi et al 5 showed various advantages of lingual mucosa, and reported their experience in one-stage onlay augmentation repair of LS-related anterior urethral stricture using a lingual mucosa graft in 36 patients with a long-term postoperative follow-up period (median 66.5 months) and a high success rate of 88.2%, which is comparable to that in previous series using buccal mucosa. 1 The authors were able to harvest a sufficient graft size (median length 8.5 cm, median width 1.8 cm) for the reconstruction of LS-related urethral strictures with low to no long-term donor site morbidity.…”

“…Although which graft to use depends on the surgeon’s preference, buccal mucosa seems to be preferred, because lingual mucosa is typically not as wide and is more flimsy . My opinion is that lingual mucosa is better in patients with a short stricture requiring only a small amount of graft, in patients with a lengthy stricture requiring additional tissue grafts other than buccal mucosa and in patients undergoing salvage urethroplasty whose buccal mucosa has already been bilaterally harvested . In contrast to my opinion, Aldaqadossi et al.…”

Penile‐preserving surgery for male distal urethral carcinoma followed by buccal mucosa urethroplasty

“…In order to prevent hematoma formation and to achieve secure graft intake, we placed dressing materials untouched for 7 days, which is longer than that in conventional staged BMG urethroplasty (5 days). This case needed wide and circumferential repair of the urethra, so we used two‐stage urethroplasty with BMG . If the intraoperative tumoral margin had been positive, we would have performed partial penectomy.…”

Regenerative medicine for urological tissues: Updated review 2018

“…In the healing process, such a bridging graft can pull both anastomotic ends, even when the graft itself shrinks. The clinical trial did not treat penile urethral reconstruction, where substitution is definitively required . Therefore, the trial of a tissue‐engineered urethra could not be judged as a clear success until further study is reported in patients truly in need of them.…”