Surgical Techniques in Substitution Urethroplasty Using Buccal Mucosa for the Treatment of Anterior Urethral Strictures

Abstract

IntroductionSince the resurgence in the use of buccal mucosa in substitution urethroplasty in the late 1980s and early 1990s, there has been controversy as to which surgical technique is the most appropriate for its application. MethodThe authors performed a literature review. Several centres have published widely on this topic, and the points considered include the use buccal mucosa (BM) in dorsal-onlay grafts, ventral-onlay grafts, tubularised grafts and the role of two-stage procedures. ResultsIn experienced hands, the outcomes of both dorsal-onlay grafts and ventral-onlay grafts in bulbar urethroplasty are very similar. The dorsal-onlay technique is however possibly less dependent on surgical expertise and therefore more suitable for surgeons new to the practice of urethroplasty. The complications associated with ventral-onlay techniques can be minimised by meticulous surgical technique, but in series with longer follow-up still tend to be more prevalent.In penile urethroplasty, two-stage dorsal onlay of BM (after complete excision of the scarred urethra) still provides the best results, although in certain circumstances a onestage dorsal-onlay procedure is possible. In general, ventral-onlay of BM and tube graft procedures in the management of penile strictures are associated with much higher rates of recurrence and should therefore be avoided. ConclusionsIn experienced hands the results of the ventral and dorsal-onlay of BM for bulbar urethroplasty are equivalent. Two-stage procedures are preferable in the penile urethra, except under certain circumstances when one-stage dorsal-onlay is feasible.

Ventral Onlay Buccal Mucosal Graft Urethroplasty Based on Tunica Vaginalis Flap for Balanitis Xerotica Obliterans Related Urethral Strictures: The Outcome of Single- Stage Reconstruction

“…Traditionally, the use of BMG as a circumferential graft has been approached with caution in the literature because of its high overall failure rates compared with onlay or 2-stage techniques. 32,33,34 However in recent times, reports have revealed an improved success rates with circular BMG for urethral substitution. 11,24 The data presented by 35 However, this technique employs a tubular BMG, which is only fixed at the proximal and distal anastomotic line without any fixation along its length.…”

Preliminary experimental study of urethral reconstruction with tissue engineering and RNA interference techniques

“…Many tissues have been used for urethral reconstruction, including vascularized or free grafts of skin as well as buccal, lingual or colonic mucosa. 6,7 However, the limited amount of autologous donor tissue limited these types of reconstruction, especially for the patients with long segment of strictures. Moreover, complications, such as recurrence, pain, swelling and oral opening limitation, often occur during the long-term follow-up.…”

A Two-Stage Buccal Mucosal Graft (BMG) for Managing Recurrent Proximal Penile Hypospadias in Pediatric & Adolescent Populations

“…In studying the outcomes of buccal mucosa (BM) penile urethroplasty, most of the studies reported a high success rate (8).…”