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329 Surgical repair of long anterior urethral stricture: Skin versus buccal mucosal grafts
329
Surgical repair of long anterior urethral stricture: Skin versus buccal mucosal grafts Eur Urol Suppl 2016;15(3);e329
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Riad A.M., Hammady A., Mamdouh A. Sohag University Hospital, Dept. of Urology, Sohag, Egypt INTRODUCTION & OBJECTIVES: The repair of long anterior urethral stricture is a challenge to re-constructive urethral surgeons. There is a debate in the literature regarding the best technique for the management of long anterior urethral stricture. In this study, we present our center’s experience in the use of skin and buccal mucosal grafts for management of long anterior urethral stricture. MATERIAL & METHODS: From October 2012 to July 2015, 24 patients with long anterior urethral stricture underwent dorsal-onlay graft augmentation urethroplasty technique using either penile skin graft in 14 patients (58.3%) or buccal mucosal graft in 10 patients (41.6%). Patients underwent preoperative retrograde urethrography, voiding cystourethrography, and uroflowmetry. These investigations were repeated 3, 6, 9 and 12 months postoperatively. Patients younger than 12 years old or with previous urethroplasty were excluded from the study. RESULTS: Twenty-four men 44.6 ± 15.8 years old were included in the study. Etiology of stricture was post-inflammatory in 12 patients (50%), post-traumatic in 7 (29%), iatrogenic in 3 (12%), and unknown in 2 patients (8%). The mean length of the stricture in the total group was 8 ± 3.4 cm. The mean preoperative Qmax in the total group was 5.9 ± 2.5 ml/s. The mean follow-up was 20.6 ± 7.7 months. Postoperative urethrograms showed patent urethral lumen in 21of 24 (87.5%). The mean postoperative Qmax in the total group was 18.2 ± 3.0 ml/s. Three patients (12.5%) developed recurrent stricture: 1(10%) in the buccal mucosal graft group (9 months postoperative), and 2 patients (14%) in penile skin graft group (3, and 6 months postoperative). There 3 cases were considered as failure because they needed further intervention. Table 1 shows a comparison of patients' age, length of urethral stricture, per- and post operative Qmax, and success rate between both groups. No statistically significant differences in postoperative Qmax or success rate ware found between the two groups. Table (1)
Parameters Number Age in years(mean ± SD)
penile skin graft buccal mucosal graft P value 14 patients 10 patients ———48.9±19.6 0.277 41.6 ± 12.2 post-inflammatory (10) post-inflammatory (2) post-traumatic (2) post-traumatic (5) Etiology (N) ———iatrogenic (1) iatrogenic (2) unknown (1) unknown (1) Stricture length (mean ± SD) 8.9 ± 3.1 cm 6.8 ± 3.6 cm 0.144 5.4 ± 2.4 ml/s 6.6 ± 2.5ml/s 0.273 Q-max preoperative Q-max postoperative 17.9 ± 3.4 ml/s 18.7 ± 2.4 ml/s 0.549 success rate 85.7% 90% 0.098
CONCLUSIONS: The use of free penile skin or buccal mucosal grafts as a tissue substitute in dorsal onlay augmentation urethroplasty for long anterior urethral stricture repair has comparable successful outcomes.
Surgical repair of long anterior urethral stricture: Skin versus buccal mucosal grafts Eur Urol Suppl 2016;15(3);e329
Print! Print!
Riad A.M., Hammady A., Mamdouh A. Sohag University Hospital, Dept. of Urology, Sohag, Egypt INTRODUCTION & OBJECTIVES: The repair of long anterior urethral stricture is a challenge to re-constructive urethral surgeons. There is a debate in the literature regarding the best technique for the management of long anterior urethral stricture. In this study, we present our center’s experience in the use of skin and buccal mucosal grafts for management of long anterior urethral stricture. MATERIAL & METHODS: From October 2012 to July 2015, 24 patients with long anterior urethral stricture underwent dorsal-onlay graft augmentation urethroplasty technique using either penile skin graft in 14 patients (58.3%) or buccal mucosal graft in 10 patients (41.6%). Patients underwent preoperative retrograde urethrography, voiding cystourethrography, and uroflowmetry. These investigations were repeated 3, 6, 9 and 12 months postoperatively. Patients younger than 12 years old or with previous urethroplasty were excluded from the study. RESULTS: Twenty-four men 44.6 ± 15.8 years old were included in the study. Etiology of stricture was post-inflammatory in 12 patients (50%), post-traumatic in 7 (29%), iatrogenic in 3 (12%), and unknown in 2 patients (8%). The mean length of the stricture in the total group was 8 ± 3.4 cm. The mean preoperative Qmax in the total group was 5.9 ± 2.5 ml/s. The mean follow-up was 20.6 ± 7.7 months. Postoperative urethrograms showed patent urethral lumen in 21of 24 (87.5%). The mean postoperative Qmax in the total group was 18.2 ± 3.0 ml/s. Three patients (12.5%) developed recurrent stricture: 1(10%) in the buccal mucosal graft group (9 months postoperative), and 2 patients (14%) in penile skin graft group (3, and 6 months postoperative). There 3 cases were considered as failure because they needed further intervention. Table 1 shows a comparison of patients' age, length of urethral stricture, per- and post operative Qmax, and success rate between both groups. No statistically significant differences in postoperative Qmax or success rate ware found between the two groups. Table (1)
Parameters Number Age in years(mean ± SD)
penile skin graft buccal mucosal graft P value 14 patients 10 patients ———48.9±19.6 0.277 41.6 ± 12.2 post-inflammatory (10) post-inflammatory (2) post-traumatic (2) post-traumatic (5) Etiology (N) ———iatrogenic (1) iatrogenic (2) unknown (1) unknown (1) Stricture length (mean ± SD) 8.9 ± 3.1 cm 6.8 ± 3.6 cm 0.144 5.4 ± 2.4 ml/s 6.6 ± 2.5ml/s 0.273 Q-max preoperative Q-max postoperative 17.9 ± 3.4 ml/s 18.7 ± 2.4 ml/s 0.549 success rate 85.7% 90% 0.098
CONCLUSIONS: The use of free penile skin or buccal mucosal grafts as a tissue substitute in dorsal onlay augmentation urethroplasty for long anterior urethral stricture repair has comparable successful outcomes.