Dorsal onlay buccal mucosal graft or penile skin graft substitution urethroplasty in bulbar urethral stricture: compare the outcome and review


  • Atul K. Khandelwal Department of Urology, BPSGMC Khanpur Kalan, Sonipat, Haryana, India



Buccal mucosa, Dorsal onlay, Penile skin, Urethroplasty


Background: Authors describe their experience with dorsal onlay urethroplasty using Buccal mucosal graft or penile skin graft through dorsal sagittal urethrotomy for bulbar urethral stricture.

Methods: From 2014 to 2017, 29 male patients with bulbar urethral stricture have been treated by one stage dorsal onlay substitution urethroplasty using buccal mucosal graft and penile skin graft. Patients with balanitis xerotica obliterans, unhealthy penile skin, oral mucosa pathology or those who had undergone more than one urethral dilation/internal urethrotomy or urethroplasty were excluded from study. Results were analyzed at 6th and 12th month follow up with clinical history and uroflowmetry. Clinical outcome was considered a failure when any postoperative instrumentation was needed, including dilation or optical internal urethrotomy.

Results: A total of 16 men age between 21 to 56 years for buccal mucosa graft (BMG) urethroplasty and 13 men age between 18 to 59 years underwent dorsal onlay substitution urethroplasty using BMG and penile skin graft (PSG). Mean stricture length was 4.2 cm (3.8-6) for BMG urethroplasty and 4.1 cm (3.2-5) for PSG urethroplasty. Mean length and width of graft were 4.2 cm and 2.6 cm respectively in BMG urethroplasty while 4.6 cm and 2.5 cm in PSAG urethroplasty. Average follow up months were 13.4 months with overall success rate 87.5% in BMG urethroplasty while average follow up months were 14.6 months with overall success rate 82.3% in PSG urethroplasty.

Conclusions: On short term follow up substitution urethroplasty using both penile skin and buccal mucosa graft have comparable results.  

Author Biography

Atul K. Khandelwal, Department of Urology, BPSGMC Khanpur Kalan, Sonipat, Haryana, India

Department of urology associate professor


Bapat SS, Padhye AS, Yadav PB, Bhave AA. Preputial skin free graft as dorsal onlay urethroplasty: our experience of 73 patients. IJU. 2007;23:366-8.

Dutta B, Rao MP, Acharya RL, Goel N, Saxena V, Trivedi S, et al. Dorsal onlay Buccal Mucosal Graft Urethroplasty in long anterior urethral stricture. Int Braz J Urol. 2007;33(2):181-7.

Dubey D, Kumar A, Mandhani A, Srivastava A, Kapoor R, Bhandari M, Buccal mucosal urethroplasty. a versatile technique for all urethral segments. BJU Int. 2005;95:625-9.

Gupta NP, Ansari MS, Dogra PN, Tandon S. Dorsal buccal mucosal graft urethroplasty by a ventral sagittal urethroplasty and minimal-access perineal approach for anterior urethral stricture. BJU Int. 2004;93:1287-90.

Bhargva S, Chapple CR. Buccal Mucosal urethroplasty: is it the new gold standard? BJU Int. 2004;93:1191-3.

Dubey D, Vijjan V, Kapoor R, Srivastava A, Mandhani A, Kumar A, et al. Dorsal onlay buccal mucosa versus penile skin flap urethroplasty for anterior urethral strictures: results from a randomized prospective trial. The Journal of urology. 2007;178(6):2466-9.

Lumen N, Oosterlinck W, Howbeke P. Urethral reconstruction using buccal mucosa or penile skin grafts: Systematic review and Meta-analysis. Urol Int. 2012;89:387-94.

Mangera A, Chapple C. Management of anterior urethral structure: an evidence-based approach. Curr Opin Urol. 2010;20:453-8.

Patterson JM, Chapple CR. Surgical techniques in substitution urethroplasty using buccal mucosa for the treatment of anterior urethral strictures. Eur Urol. 2008;53:1162-71.

Humby GA. A one-stage operation for hypospadias repair. Br J Surg. 1941;29:84-92.

Bhargava S, Chapple CR. Buccal mucosal urethroplasty: is it the new gold standard? 2004;93(9):1191-3.

Blum JA, Feeny MJ, Howe JE, Steel JF. Skin patch urethroplasty;5 year follow up. J Urol. 1982;127:909.

Presman D, Greenfield DL. Reconstruction of the perineal urethra with a free full-thickness skin graft from the prepuce. J Urol. 1953;69:677-80.

Payton AB, Headstream JW. Construction of perineal urethra by spilt thickness skin graft J Urol. 1956:76:90-3.

Divine CJ Jr, Horton CE. A one stage hypospadias repair. J Urol. 1961;85:166-72.

Devine PC, Horton CE, Devine CJ Sr, Devine CJ Jr, Crawford HH, Adamson JE. Use of full thickness skin grafts in repair of urethral strictures. J Urol. 1963;90:67-71.

Barbagli G, Palminteri E, Rizzo M. Dorsal onlay graft urethroplasty using penile skin or buccal mucosa in adult bulbourethral stricture. J Urol. 1998;160:1307-9.

Alsikafi NF, Eisenberg M, McAninch JW. Long term outcomes of penile skin graft versus buccal mucosal graft for substitution urethroplasty of the anterior urethra. J Urol. 2005;173:187.

Barbagli G, Guazzoni G, Lazzeri M. One stage bulbar urethroplasty: retrospective analysis of the results in 375 patients. Eur Urol. 2008;53:828-33.

Markiewicz MR, Lukose MA, Margarone JE, Barbagli G, Miller KS, Chuang SK. The oral mucosa graft: a systematic review. J Urol. 2007;178:387-94.

Markiewicz MR, Margarone JE Barbegli G, Scannapieco FA. Oral mucosa harvest: An overview of anatomic and biologic consideration. Eur Assoc Urol. 2007;5:179-87.

Barbagli G, Vallasciani S, Romano G, Fabbri F, Guazzoni G, Lazzeri M. Morbidity of oral mucosa graft harvesting from a single cheek. Eur Urol. 2010;58:33-41.

Wood DN, Allen SE, Andrich DE, Greenwell TJ, Mundy AR. The morbidity of buccal mucosal graft harvest for urethroplasty and effect of nonclosure of the graft harvest site on postoperative pain. J Urol. 2004;172:580-3.

Dublin N, Stewart LH. Oral complications after buccal mucosal graft harvest for urethroplasty. BJU Int. 2004;94:867-9.

Oosterlinck W, Lumen N, Van Cauwenberghe G. Surgical treatment of urethral stenoses: technical aspects (in French). Ann Urol. 2007;41:173-207.

Andrich DE, Leach CJ, Mundy AR. The Barbagli procedure gives the best results for patch urethroplasty of the bulbar urethra. BJU Int. 2001;88:385-9.

Raber M, Naspro R, Scapeticci E, Salonia A, Scattoni V, Mazzoccoli B, et al. Dorsal onlay graft urethroplasty using penile skin or buccal mucosa for repair of bulbar urethral stricture: result of prospective single centre study. Eur Urol. 2005;48:1013-7.

Pansadoro V, Emiliozzi P, Gaffi M, Scarpone P, DePaula F, Pizzo M. Buccal mucosa urethroplasty in the treatment of bulbar urethral stricture. Urology. 2003;61:1008-10.

Dubey D, Kumar A, Bansal P, Srivastava A, Kapoor R, Mandhani A, et al. Substitution urethroplasty for anterior urethral stricture: a critical appraisal of various techniques. BJU Int. 2003;91:215-8.

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 urethra: are results affected by surgical technique? J Urol. 2005;174:955-8.

Barbagli G, De Stefani S, Sighinolfi MC, Annino F, Micali S, Bianchi G. Bulbar urethroplasty with dorsal onlay buccal mucosal graft and fibrin glue. Eur Urol. 2006;50:467-74.

Xu Y-M, Qiao Y, Sa Y-L, Wu DL, Zhang XR, Zhang J, et al. Substitution urethroplasty of complex and long- segment urethral stricture: a rationale for procedure selection. Eur Urol. 2007;51:1093-9.

Barbagli G, Palminteri E, Lazzeri M, Guazzoni G, Turini D. long term outcome of urethroplasty after failed urethrotomy versus primary repair. J Uol. 2001;165:1918-9.

Barbagli G, Palminteri E, Lazzeri M, Turini D. Interim outcomes of dorsal skin graft bulbar urethroplasty. J Urol. 2004;172:1365-7.






Original Research Articles