Ventral and Dorsal Buccal Grafting for 1-Stage Repair of Complex Anterior Urethral Strictures

Abstract

ObjectiveTo describe our 14-year experience with a 1-stage tissue transfer urethroplasty technique.MethodsEighteen patients underwent reconstruction with circumferential buccal grafting. All patients had anterior urethral strictures that included segments of total or near-total obliteration not amenable to excisional or augmented anastomotic repair and intact corpus spongiosum that could serve as a graft recipient bed. The mobilized corpus spongiosum was incised dorsally without transection, thereby preserving the continuity of the blood supply within the spongy tissue. Buccal mucosa was quilted to the corporal bodies to reconstruct the dorsal aspect of the urethra. Where there was obliterative or near-obliterative stricture disease, additional buccal mucosa was quilted to the dorsally incised, nontransected corpus spongiosum in continuity with the distally and proximally spatulated urethra. The repair was then completed by approximating dorsal and ventral buccal mucosal graft segments.ResultsFollow-up included voiding cystourethrogram at 3 weeks, cystoscopy 4 months after surgery (1 patient refused), and subsequent follow-up. There was 1 early stricture recurrence, which was successfully treated with direct vision internal urethrotomy (success 94%, and 100% after 1 urethrotomy). Every patient was contacted and assessed at the time of manuscript preparation. All patients are currently free of obstructive symptoms attributed to stricture disease with a mean follow-up of 50 months (range, 5-171 months).ConclusionDorsal and ventral buccal grafting appears to be an excellent option for a 1-stage repair of long obliterative anterior urethral strictures and strictures that include segments of obliterative or near-obliterative disease in selected cases. To describe our 14-year experience with a 1-stage tissue transfer urethroplasty technique. Eighteen patients underwent reconstruction with circumferential buccal grafting. All patients had anterior urethral strictures that included segments of total or near-total obliteration not amenable to excisional or augmented anastomotic repair and intact corpus spongiosum that could serve as a graft recipient bed. The mobilized corpus spongiosum was incised dorsally without transection, thereby preserving the continuity of the blood supply within the spongy tissue. Buccal mucosa was quilted to the corporal bodies to reconstruct the dorsal aspect of the urethra. Where there was obliterative or near-obliterative stricture disease, additional buccal mucosa was quilted to the dorsally incised, nontransected corpus spongiosum in continuity with the distally and proximally spatulated urethra. The repair was then completed by approximating dorsal and ventral buccal mucosal graft segments. Follow-up included voiding cystourethrogram at 3 weeks, cystoscopy 4 months after surgery (1 patient refused), and subsequent follow-up. There was 1 early stricture recurrence, which was successfully treated with direct vision internal urethrotomy (success 94%, and 100% after 1 urethrotomy). Every patient was contacted and assessed at the time of manuscript preparation. All patients are currently free of obstructive symptoms attributed to stricture disease with a mean follow-up of 50 months (range, 5-171 months). Dorsal and ventral buccal grafting appears to be an excellent option for a 1-stage repair of long obliterative anterior urethral strictures and strictures that include segments of obliterative or near-obliterative disease in selected cases.