Buccal mucosa graft urethroplasty for bulbar urethral stenosis repair

350

349 FLEXIBLE FOLLOWING DISEASE

CYSTOURETHROSCOPY UP PATIENTS WITH

IS THE BEST WAY OF URETHRAL STRICTURE

Chapple Christopher, Goonesinche Satish, Nicholson Timothy. Department

De Nunrio

Cosimo

The Royal Hallamshire Hospital, Sheffield. United Kingdom

of Urology.

& OBJECTIVES: Urethra strictures can be difficult to be diagnosed during their early stages since the flow rate does not diminish until the calibre of the urethra is 3 mm or less. In the past accurate follow up following urethra surgery has relied upon contrast imaging. No previous studies have evaluated the role of cystourethroscopy in this context. INTRODUCTION

& METHODS: A prospective review of I41 patients with adequate follow up treated by a single surgeon over a 9 year period is reported.

MATERIAL

122 patients had undergone a flexible cystourethroscopy on a regular basts during the postoperative follow-up. The median follow-up was 30 months (mean 33.8, SD 25.4, range 3-96). 41 of those patients (33.6%) have undergone previous urethroplasty. The remainder had failed either urethrotomy or dilatation. 3 I (25.4%) had developed a stricture following trauma. The mean age at surgery was 37.6 years (SD 13.0, range 20-74) Following urethroplasty, 26 out 122 patients (20.4%) required further intervention. In I2 patients there was a thin diaphragm at the anastomotic site treated by gentle dilatation or urethrotomy without further recurrence. I4 patients developed significant restenosis at the site of urethroplasty. In 96 patients (79%) no further intervention of any sort was necessary. Overall 3 patients (7.3%) following redo urethroplasties and 9 (I I .I W) following non-redo urethroplasties were found to have diaphragms. Significant restenosis was seen in 8 patients (19.5%) with redo procedures and in 6 patients (7.4%) following non-redo procedures. In the patients who had anastomotic urethroplasties, 8 (10.2%) had diaphragms and 5 (6.4%) had significant restenosis. Among the patients who had some form of substitution urethroplasty, diaphragms were seen in 4 patients (9.3%) and significant restenosis in 9 patients (20.9%) Overall within the group of patients who have had buccle mucosa substitutions, 2 patients (I 1.1%) had diaphragms and 3 (16.6%) had significant restenosis. Within the non-buccal mucosa substitution group, diaphragms were seen in 2 patients (7.1%) and significant restenosis in 6 patients (21.4%).

RESULTS:

Urethroplasty is a very effective surgical procedure in the management of urethra strictures, even in the patients who have undergone previous urethroplasty surgery. 897~ of patients during a 2’h years follow-up remained free of their urethra strictures. Accurate follow-up of patients is important to identify those who develop recurrent stricture disease. Many of the patients with restenoais defined in this study would not have been picked up for some time, if follow-up had been based on flow rate analysis. CONCLUSIONS:

ASSESSMENT OF URETHRAL STRICURES AND ASSOCIATED ABNORMALITIES OF THE CORPUS SPONGIOSUM BY MEANS OF THE NEW EXTENDED FIELD OF VIEW ULTRASOUND TECHNOLOGY Radmavr

Christian’,Klauser Andrea’, Frauscher Ferdinand’, Bartsch Georg’

‘Urology, University of Innsbruck, of Innsbruck, Innsbruck, Austria

Innsbruck,

Austria, Radiology,

Urethral ultrasound (US) is a new tool INTRODUCTION & OBJECTIVES: in diagnosing urethral strictures. However the limited field of view (FOV) of the standard US technique is a major disadvantage. The new SieScaperM (Siemens. Germany) US technology is capable of producing high-resolution images up to 60 cm in length. In the present study we compared the standard US technique to the new SieScapeTM technology.

MATERIALS & METHODS: In 36 male patients with a mean age of 43 years both US techniques were applied. All patients presented with urethral strictures as proven by means of standard retrograde ureterography. Longitudinal scans were obtained using either a 12.0 or 7.5 MHz linear probe. During real time scanning the SieScapeTM produces a large composite image using an image based position sensing technique visualising the whole uretera in one single scan. For classification purposes we used the five grade scale of urethral strictures proposed by Chiou et al on the basis of US and reflection of the amount of peri urethral spongiofibrosis. RESULTS: Seventeen patients presented with grade I, IO with grade II, 5 with grade III, I with grade IV, and 3 with grade V ureteral strictures, respectively. Both, the standard US and the new extended FOV ultrasound accurately demonstrated the length and calibre of the strictures as well as any abnormalities of the corpus spongiosum. However, the entire length of the urethra and the topographic morphology of multiple strictures could only be evaluated in one image when using the SieScapeTM ultrasound technique. CONCLUSION: Ureteral visualising and assessing additionally in the urethral technology proved superior potential and interpretation

US is a very simple, non-invasive and useful tool in pathologic changes not only in the urethra but wall and urethral surrounding. The new SieScape.‘-M to the standard US technique in terms of diagnostic of the US image.

351 BUCCAL BULBAR

MUCOSA URETHROPLASTY URETHRAL STRICTURES

Panaadoro

Vito’,

Emiliozzi

‘Urology,

V. Pansadoro

lUrology,

San Camille

reconstruction

median

Paolo’,

Pizza

Maurizio’,

Rome,

Italy.

‘Urology,

HP, Rome,

San Giovanni

gaining

popularity. mucosa

use We

of

buccal

report

mainly

mucosa

our

7.year

as a dorsal

for

Since June 1994 to February

bulbar

Sixty-three

3); ten patients

urethra

patients (15%)

have

(97%)

been

had undergone

had also undergone

with

previous

previous

patients

buccal

technique

Preoperative Stamey

with

evaluation

the bulbar

endoscopic free graft

Orandi

infection.

urethra

section

urethroplasty

included

test for urmary

inciston,

uroflow, Epidural

is exposed

of the stricture

of buccal

failed

mucosa

was used on panurethral retrograde

anaestheaia

and detached

is performed

is obtained

and

the corpora

at 12 o’clock

and careful

voiding

is used. Through

from

urethrotomy

(I -7,

A ventral

with

defattening

catheter when

Perineal

is left postoperatively

micturating

RESULTS: included

Median

is applied

a

disease.

urethrocystogram, a perineal

midline Complete

a 20 Fr. urethrotome.

is performed.

A

The graft

is now

periurethral

prolonged

37

months

leakage

suprapubic

I6 Fr. silicone

tube is left up to the second week,

(range

at voiding

drainage

6-X7).

Early

complications

cystourethrogram,

(4 and 6 weeks).

Patients

that

healed

have been

with periodic uroflow and urethrocyatogram at 6, 12 months and then yearly. stricture recurred in of 9 patients treated where a ventral graft was used, whde no

I

recurrence occurred tn 56 patients treated with dorsal onlay. Overall success rate was 98% (64165). Except for one recurrence, all these patients have asymptomatic voiding. with urmary peak flow 15 ml/aec. Urethrocystogram shobs a wide urethral caliber. sometimes with

non-obstructing

CONCLUSION: solution

irregularity Dorsal

for treatment

graft

of bulbar

of the ventral buccal ureteral

European Urology Supplements

mncosa

urethra. urethroplasty

seems to provide

stoctnres.

1 (2002) No. 1, pp. 90

Abatang

Giuseppe,

Meneghi

of Urology,

S. Bortolo Hospital. Vicenza, Italy

INTRODUCTION & OBJECTIVES: Evaluation of the use of buccal mucosa graft as single stage urethral reconstruction in an adult population with a stenosis of the bulbar urethra.

an excellent

MATERIALS & METHODS: In our Department from April 1996 and May 2001, 31 patients with bulbar urethral stenosis underwent single stage urethroplasty using a buccal mucosa graft. Mean age of patients was 52 years (range 14-72). The aetiology of urethral stricture was inflammation (8 cases), iatrogenic (7 cases) and idiopathic (16 cases). A ventral onlay patch (mean length 4.6 cm, range 2.5-7 cm) was employed in all cases. Any objective (uroflowmetry, voiding cystourethrogram) or subjective modification in urinary flow leading to urethral instrumentation was considered as failure criterion.

is

Vicryl 410 sutures. The Penrose drainage is left

for 5 days. A grooved

suprnpubic

patients

is performed.

follow-up

patients

with

dressmg

for one week.A

cystogram

in two

spontaneously followed Urethral

compressive

onlay

age was 41

stricture

cavernosa.

Antonio,

with &raft

urethroplasty.

sutured to the border of the open urethra with a series of interrupted same stitches are used to fix the uretera to the corpora cavernosa.A for 24 hours.

of

mncosa

was used in 9 patients and a dorsal onlay in the remaining 56 patients. Mean years (14.69). The median length of the stricture was 4 cm (2-l 6). In nine combmed

with

in the treatment

2001, sixty-fwe

treated

Paolo. Cacciol

BULBAR

urethral

experience

onlay

Ferrare

FOR

Italy. Depaertment

The

of buccal

& METHODS:

352 BUCCAL MUCOSA GRAFT URETHROPLASTY URETHRAL STENOSIS REPAIR Tasca Andrea, Agostino

Italy

a graft

involving

urethroplasty.

Scarpone

OF

strictures.

MATERIALS a stricture

Foundation.

rapidly

with

urethral

Marco’,

& OBJECTIVES:

is

urethroplasty

Gaffi

TREATMENT

Alberta’

HP, Rome.

INTRODUCTION

bulbar

Paolo’.

Francesco' . Pansadoro

DePaula

IN THE

‘University

RESULTS: During the follow-up (median 26 months, range 6-52 months) the overall success rate was 83% (2613 I patients). The success rate was 758 (h/X patients) for inflammatory strictures. 85% (617 patients) for iatrogenic strictures and 87% (I4116 patients) for strictures of unknown aetiology. Three out of the 5 patient who relapsed underwent internal urethrotomy and then a course of 6 weekly pneumatic dilation of the treated area. Two patients in whom the postoperative x-ray control showed urethral outlet irregularity at the site of the onlay, underwent 6 weekly calibrations with a 22F catheter. After an average follow-up of 36 months (range 18-48 months) none of these 5 patients relapsed. CONCLUSION: Free graft urethroplasty with buccal mucosa graft represents a simple surgical option that has produced good results. In selected cases this procedure seems to represent the first choice solution in treating bulbar urethral stenoaes.