Two-Sided Bulbar Urethroplasty Using Dorsal Plus Ventral Oral Graft: Urinary and Sexual Outcomes of a New Technique

• Published in: The Journal of urology Vol. 185; no. 5; pp. 1766 - 1771
• Main Authors: Palminteri, Enzo, Berdondini, Elisa, Shokeir, Ahmed A, Iannotta, Luca, Gentile, Vincenzo, Sciarra, Alessandro
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2011; Elsevier
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Child; Erectile Dysfunction - epidemiology; Humans; Male; Medical sciences; Middle Aged; mouth mucosa; Mouth Mucosa - transplantation; Nephrology. Urinary tract diseases; Patient Care Team; Postoperative Complications - epidemiology; Reconstructive Surgical Procedures - methods; Surveys and Questionnaires; transplants; Treatment Outcome; urethra; urethral stricture; Urethral Stricture - surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urology; buccal mucosa; extended anastomotic urethroplasty; BM; urethra; dorsal plus ventral graft; AU; DVG; Qmax; EPA; urethral stricture; EAU; excision and primary anastomosis; mouth mucosa; anastomotic urethroplasty; transplants; peak flow rate; Urine; Drug combination; Nephrology; Urinary system disease; Urethral disease; Prognosis; Mucosa; Oral administration; Urinary tract disease; Urology; Urethroplasty; Plasty; Treatment; Urethra; Surgery; Graft; Technique; Urethral stenosis
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1016/j.juro.2010.12.103

Purpose Repair of bulbar strictures using anastomotic techniques may cause sexual complications, while 1-side graft urethroplasties may not be sufficient to provide an adequate lumen in narrow strictures. We evaluated the urinary and sexual results of a 2-sided dorsal plus ventral graft urethroplasty by preserving the narrow urethral plate in tight strictures. Materials and Methods Between 2002 and 2010, 105 men with bulbar strictures underwent dorsal plus ventral graft urethroplasty. The results are reported in a homogeneous group of 73 of 105 cases in which buccal mucosa was used as a graft with findings after 1 year or more of followup. The urethra was opened ventrally, and the exposed dorsal urethra was incised in the midline to create a raw area over the tunica albuginea where the first graft was placed dorsal-inlay. Thereafter the urethra was augmented by the ventral-onlay second graft and the spongiosum was closed over itself. Successful urethral reconstruction was defined as normal voiding without the need for any postoperative procedure. Postoperative sexual dysfunction was investigated using a validated questionnaire. Results Mean followup was 48.9 months and mean stricture length was 3.3 cm. Of these 73 cases 64 (88%) were successful and 9 (12%) were treatment failures with re-stricture. Furthermore, of 49 of 73 cases who were preoperatively sexually active, none reported postoperative erectile impairment and all were satisfied with their sexual life. Conclusions In cases of tight bulbar stricture the dorsal plus ventral buccal mucosa graft provides adequate urethral augmentation by preserving the urethral plate and avoiding postoperative sexual complications.