Double faced buccal mucosal graft urethroplasty for near obliterative inflammatory urethral stricture: a retrospective study comparing two different techniques
DOI:
https://doi.org/10.18203/2349-2902.isj20240927Keywords:
Buccal mucosal graft urethroplasty, Enzo palminteri, Joel Gelman techniqueAbstract
Background: Double-faced urethroplasty offers improved outcomes for the management of complex urethral strictures. In our study, we compared two different techniques of double faced buccal mucosal graft (BMG) urethroplasty.
Methods: 46 patients who underwent double faced BMG urethroplasty at Ramaiah Medical College were retrospectively reviewed and grouped into A (Enzo Palminteri technique) and B (Joel Gelman technique). Post operatively, patients were followed up with AUA-SS, uroflowmetry and postvoid residual assessment. The data analysis was done using the statistical package for the social sciences (SPSS) version 21.0. A p<0.05 was considered statistically significant.
Results: 24 patients belonged to group A and 22 patients belonged to group B. The mean stricture length measured was 4.42±1.632 cm in group A and 4.11±1.634 cm in group B with the preoperative mean Qmax and AUA score was 7±1.318 ml/s and 19.75±3.286 in group A and 7.3±1.497 ml/s and 18.68±3.469 in group B. Mean operative time was 162.7±12.156 minutes versus 181.36±7.429 minutes. Group A patients had significant intraoperative blood loss. Recurrence was noted in two patients, one from each group. Mean Qmax and mean AUA score at recent follow up was 19.3±1.63 ml/s and 6.4±2.10 versus 19.8±1.59 ml/s and 6.6±2.03 for group A and group B with a mean follow up of 36.6±12.63 months and 36.8±11.48 months respectively.
Conclusions: Double faced BMG urethroplasty for near obliterative urethral stricture is safe, efficacious with ventral onlay associated with lesser operative time.
Metrics
References
Santucci RA, Mario LA, McAninch JW. Anastomotic urethroplasty for bulbar urethral stricture: analysis of 168 patients. J Urol. 2002;167(4):1715-9.
Guralnick ML, Webster GD. The augmented anastomotic urethroplasty: indications and outcome in 29 patients. J Urol. 2001;165(5):1496-501.
Elliott SP, Metro MJ, McAninch JW. Long-term followup of the ventrally placed buccal mucosa onlay graft in bulbar urethral reconstruction. J Urol. 2003;169(5):1754-7.
Wessels H, McAninch JW. Use of free grafts in urethral stricture reconstruction. J Urol. 1996;155(6):1912-5.
Baskin LS, Duckett JW. Buccal mucosa grafts in hypospadias surgery. Br J Urol. 1995;76(3):23-30.
Barbagli G, Palminteri E, Rizzo M. Dorsal onlay graft urethroplasty using penile skin or buccal mucosa in adult bulbourethral strictures. J Urol. 1998;160(4):1307-9.
Pansadoro V, Emiliozzi P, Gaffi M, Scarpone P. Buccal mucosa urethroplasty for the treatment of bulbar urethral strictures. J Urol. 1999;161(5):1501-3.
Morey AF, McAninch JW. When and how to use buccal mucosal grafts in adult bulbar urethroplasty. Urology. 1996;48(2):194-8.
Kane CJ, Tarman GJ, Summerton DJ, Buchmann CE, Ward JF, O'Reilly KJ, et al. Multi-institutional experience with buccalmucosa onlay urethroplasty for bulbar urethral reconstruction. J Urol. 2002;167(3):1314-7.
Barbagli G, Palminteri E, Guazzoni G, Montorsi F, Turini D, Lazzeri M. Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique? J Urol. 2005;174(3):955-8.
Blaschko SD, McAninch JW, Myers JB, Schlomer BJ, Breyer BN. Repeat urethroplasty after failedurethral reconstruction: outcome analysis of 130 patients. J Urol. 2012;188(6):2260-4.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13.
Palminteri E, Manzoni G, Mordondoni E, Di Fiore F, Testa G, Poluzzi M, et al. Combined dorsal plus ventral double buccal mucosa graft in bulbar urethral reconstruction. Eur Urol. 2008;53:81-90.
Gelman J, Siegel JA. Ventral and Dorsal Buccal Grafting for 1-Stage Repair of Complex Anterior Urethral Strictures. Urology. 2014;83:(6).