Dorsal Onlay Buccal Mucosal Graft Urethroplasty for Long Segment Anterior Urethral Strictures: A Retrospective Study of Mid and Long-term Outcomes

Abstract

Introduction: Dorsal onlay urethroplasty with Buccal Mucosal Graft (BMG) is the single stage procedure and is most commonly used to treat long segment anterior urethral strictures. Unilateral mobilisation of the urethra prevents both chordee and ischaemia. Aim: To evaluate the feasibility, medium-term and long-term outcomes of dorsal onlay BMGs when used to treat long anterior segment penile urethral stricture with unilateral mobilisation of the urethra. Materials and Methods: A retrospective study was conducted in Kasturba Hospital, Manipal, Karnataka, India, from January 2008-December 2018. A total of 56 patients with long anterior segment penile urethral strictures underwent BMG substitution for urethroplasty, with a follow-up period ranging from 1.2-10 years. The outcome of the procedure was assessed through clinical history and physical examination, uroflowmetry, retrograde and voiding cystourethrography and urethroscopy {6 French gauge (Fr)}. Statistical analysis was performed using the mean and median. Results: The mean age of 56 patients was 51.8±9.9 years, with a mean±Standard Deviation (SD) Maximum Flow Rate (MFR) of 20.1±5.3 mL at one month and 18.1±4.3 mL at three and 18.7±3.7 mL six months, 17.3±5.1 mL, 19.3±4.3 mL and 18.6±3.7 mL at one year, 2-5 years and 10 years postoperative respectively. Postvoid Residual urine (PVR) volume was higher till one year follow-up (i.e., first month it was 38.6±23.6 mL in 47 patients, third month it was 45.8±22.4 mL in 12 patients, sixth month it was 49.0±28.8 mL in 14 patients and one year follow-up it was 43.9±30.8 mL in 24 patients). Minimal complications were noted over 5-10 years follow-up. Conclusion: For long segment anterior penile urethral strictures, unilateral mobilisation in BMG urethroplasty had shown success over both medium and long-term periods.

Keywords

• buccal graft
• dilation
• postvoid residual urine
• substitution urethroplasty
• urethrotomy