Transurethral ventral buccal mucosa graft inlay for treatment of distal urethral strictures: international multi-institutional experience

Daneshvar, Michael; Simhan, Jay; Blakely, Stephen; Angulo, Javier C.; Lucas, Jacob; Hunter, Craig; Chee, Justin; Alvarado, Damian López; Pérez, Erick Alejandro Ramírez; Madala, Alosh; Benito, Juan José de; Martins, Francisco E.; Felício, João; Rusilko, Paul; Flynn, Brian J.; Nikolavsky, Dmitriy

doi:10.1007/s00345-019-03061-6

Cited by 16 publications

(9 citation statements)

References 22 publications

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“…The graft is then harvested and sutured to the ventral graft bed with transcutaneously placed sutures which allows for accurate graft positioning as well as facilitating its placement. In a recent multi-institutional study including 68 patients, 95% of patients stayed recurrence-free at nearly 1.5 years of follow-up utilizing this technique (9). While technically more challenging than a dorsal inlay, it allows for removal of at least part of the stricture decreasing recurrence rate and also avoiding the possible (albeit theoretical in our experience) risk of fistula formation and glans dehiscence.…”

Section: Ventral Inlaymentioning

confidence: 82%

Narrative review of penile distal urethroplasties and suggestions for optimizing outcomes

Hofer¹,

Cooley²,

Martins³

2021

Transl Androl Urol

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Distal urethral strictures can be a challenging entity for urologists. Endoscopic maneuvers such as optical internal urethrotomies or dilations are even less successful than in other urethral locations and the repeated trauma will increase the scarring which advocates for a urethroplasty as primary option for patient management. Success rates of distal urethroplasties have been lower than those for other urethral strictures due to the anatomy of the distal urethra with a very thin corpus spongiosum associated with decreased mucosal blood supply. Also, the high prevalence of lichen sclerosus in this population with circumferential scarring is often a complicating factor. However, in the past two decades several surgical techniques have been described and further developed which has led to significant improvement in stricture recurrence rates.Meatoplasties are indicated for strictures limited to the meatus and involve opening of the stenotic meatus with subsequent reconstruction of it to minimize spraying of urine. Often, however, distal urethral strictures involve the fossa navicularis and may even extend further proximally. These strictures can be addressed with dorsal or ventral inlay procedures using buccal mucosa graft. In addition or alternatively, skin flaps can be mobilized to increase the urethral diameter. Lastly, multi-stage urethroplasty with buccal mucosa are a very successful approach yet given the high success rates of above mentioned procedures are usually reserved for revision surgery or most severe distal urethral strictures. In the following report, we are describing a variety of surgical techniques and their indication which should allow the practicing urologist to successfully address all encountered distal urethral strictures.

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Section: Ventral Inlaymentioning

confidence: 82%

Narrative review of penile distal urethroplasties and suggestions for optimizing outcomes

Hofer¹,

Cooley²,

Martins³

2021

Transl Androl Urol

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“…They hypothesized that this technique yields good results without glans dehiscence and fistula formation. In 2020, an international multi-institutional retrospective study by Daneshvar et al [ 19 ] reported on this same technique. They included 68 patients with a median stricture length of 2 cm.…”

Section: Discussionmentioning

confidence: 99%

“…We would like to highlight that our population is heterogeneous and that patients with LS or FHR might already have sensitivity problems of their glans. Daneshvar et al [ 19 ] are the first to report patient-reported outcomes following distal urethral reconstruction. Their population was equally heterogeneous.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Meatal Strictures by Dorsal Inlay Oral Mucosa Graft Urethroplasty: A Single-Center Experience

Wirtz

Claeys

Francois

et al. 2021

JCM

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Background: To report on the use of oral mucosa graft urethroplasty for meatal strictures using the dorsal inlay technique. Methods: Patients who underwent a single-stage dorsal inlay oral mucosal graft urethroplasty between January 2000 and May 2021 were included in this study. A follow-up of a minimum of 12 months was necessary for inclusion. Exclusion criteria were stricture extension into the penile urethra, concomitant stricture at another location, flap urethroplasty for a meatal stricture, dorsal inlay urethroplasty with another type of graft, ventral onlay graft urethroplasty or staged urethroplasty. Recurrence was defined by the inability to pass a 14F metal sound through the reconstructed meatus irrespective of patients’ complaints. Results: Our study cohort included 40 patients. Buccal mucosal graft (BMG) urethroplasty was used in 25 patients and 15 patients were treated with the aid of lingual mucosal graft (LMG). The median follow-up was 85 (IQR: 69–110) months. Seven (17.5%) patients suffered a stricture recurrence of which four (10%) needed re-intervention. The median 5-y recurrent free survival (RFS) for the entire cohort was 85 (±6)%. The median 5-y RFS was 96 (±4)% versus 65 (±13)% for respectively BMG and LMG (p = 0.03). Post-operative complications were identified in 11 (27.5%) patients with only one (2.5%) patient who had a grade 3a complication. Conclusions: Dorsal inlay oral mucosa graft urethroplasty is a safe and feasible technique for selected patients with meatal stenosis.

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“…Le traitement de la sténose urétrale à évoluer passant de la dilatation à l'urethrotomie interne et à la plastie. Les indications de la technique opératoire sont de plus en plus précises (Oosterlinck, 2015;Wessels, 2017;Hussain, 2020;Daneshvar, 2020;Buckley, 2014).…”

Section: Discussionunclassified

Profils Épidémiologiques, Cliniques et Thérapeutiques de la Sténose Urétrale de L’homme à l’Hôpital National de Zinder (HNZ), Niger

Halidou

Adamou

Hassane

et al. 2020

ESJ

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Objective: To describe the epidemiological, clinical and therapeutic aspects of urethral stenosis at Zinder National Hospital (ZNH) NIGER. Patients and methods: This was a descriptive retrospective study carried out in the Department of Urology of the ZNH during the period from January 2016 to December 2019. We collected 116 medical records of patients, in whom the diagnosis of narrowed Urethral donation was performed and documented by retrograde and voiding urethro-cystography and managed. Results: During Fifteen patients (12.93) were lost to follow-up after their first evaluation. Conclusion:Stenosis of the urethra is a common condition in consultations at the NHZ. Patients often consult for complications. The UC is the key to the topographic diagnosis of the lesion. Resection with end to end anastomosis gives good results. Plasties with mucosal or skin grafting still remain a challenge in our context.

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Transurethral ventral buccal mucosa graft inlay for treatment of distal urethral strictures: international multi-institutional experience

Cited by 16 publications

References 22 publications

Narrative review of penile distal urethroplasties and suggestions for optimizing outcomes

Narrative review of penile distal urethroplasties and suggestions for optimizing outcomes

Treatment of Meatal Strictures by Dorsal Inlay Oral Mucosa Graft Urethroplasty: A Single-Center Experience

Profils Épidémiologiques, Cliniques et Thérapeutiques de la Sténose Urétrale de L’homme à l’Hôpital National de Zinder (HNZ), Niger

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