Buccal mucosal graft urethroplasty - a follow up study

Abstract

According to WHO definition narrowing of the part of urethra surrounded by corpus spongiosum is called stricture. The causes of anterior urethral stricture are idiopathic, acquired and iatrogenic. Short strictures (<3 cm) usually are amenable to stricture excision and end-to-end anastomosis with 100% success rate. However, reconstruction of stricture more than 3 cm often leads to chordee and impotence. Hence, in most centre’s long strictures have been treated by substitution urethroplasty. Various genital and extra-genital skin grafts have been used for substitution urethroplasty, but with higher chances of graft necrosis leading to recurrence and donor site morbidity. Buccal mucosa graft (BMG) has emerged as a versatile substitute to deal with this condition. Materials and Methods: To observe the outcome of buccal mucosal graft urethroplasty for long anterior urethral stricture of 3 cm or more by dorsal onlay technique through perineal approach. From January 2015 to January 2016. 11 patients with long anterior urethral strictures of 3 cm or more were selected. Those patients were subjected to clinical examination, uroflowmetry, ascending urethrogram and opposing urethrogram if required.  Patients with complex urethral strictures, unhealthy buccal mucosa were excluded from the study and treatment option. Pre-operative supra pubic cystostomy placement ensured for all patients, Dental evaluation done to rule out submucosal fibrosis. Genitalia and perineum prepared with betadine scrub for 3 days, Antiseptic mouth wash was advised for 3 days, Parenteral broad spectrum antibiotic was started on the day of surgery and continued for 5 days postoperatively. Single staged dorsal onlay buccal mucosal graft urethroplasty is a good definitive procedure and should be offered to patients with anterior urethral stricture who require more than one Visual Internal Urethrotomy. Limitations in this study are short follow up period and small sample size.