Ventral onlay urethroplasty using buccal mucosa for complex stricture repair

• Published in: Urology (Ridgewood, N.J.) Vol. 61; no. 5; pp. 1004 - 1007
• Main Authors: Heinke, Tobias, Gerharz, Elmar W, Bonfig, Roland, Riedmiller, Hubertus
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2003; Elsevier Science
• Subjects: Adult; Aged; Biological and medical sciences; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Mouth Mucosa - surgery; Mouth Mucosa - transplantation; Nephrology. Urinary tract diseases; Patient Satisfaction; Prospective Studies; Reconstructive Surgical Procedures - methods; Recurrence; Reoperation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Surveys and Questionnaires; Transplantation, Autologous; Treatment Failure; Treatment Refusal; Urethral Stricture - surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urologic Surgical Procedures, Male - methods; Human; Performance evaluation; Corrective surgery; Urethral disease; Treatment efficiency; Mucosa; Male urethra; Urogenital system diseases; Exploration; Male; Anatomical reconstruction; Striction; Oral cavity; Surgery; Urethrography; Medical imagery; Adult; Technique; Bibliographic review
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/S0090-4295(02)02523-2

To report the short to medium-term results of one-stage buccal mucosa ventral onlay in the treatment of recurrent urethral stricture disease. Between April 1997 and July 2001, buccal mucosa was used as a ventral onlay graft in 38 patients with recurrent strictures of the bulbar (n = 30) and proximal penile urethra (n = 8). All patients had undergone at least 1 urethrotomy (range 1 to 10; mean 2.9) before reconstruction. Prospective follow-up included a simple questionnaire on patient satisfaction, uroflowmetry, and ultrasound estimation of postvoid residual urine volume and, in the case of recurrence, retrograde urethrography and cystoscopy. The primary success rate at a mean follow-up of 22.8 months (range 8.7 to 40.7) was 80%. Stricture recurred in 7 patients, mostly within 12 months. A distinct residual irregularity at the former stricture site in the initial postoperative urethrogram was predictive of failed reconstruction. A second procedure was performed in 4 patients (1 urethrotomy and 3 re-buccal mucosa onlay grafts) with good results. Patient satisfaction was high in most instances. Three patients refused reoperation, preferring regular intermittent dilation. When end-to-end anastomosis is impossible, onlay urethroplasty using buccal mucosa is a rather simple alternative with encouraging short to medium-term results in the proximal segments of the male urethra.