Introduction: Long urethral strictures with an obliterative segment remain a technical challenge when attempting a durable operative repair. An augmented anastomotic urethroplasty using buccal mucosa is typically performed in these cases, but the ideal position of the buccal graft is still under debate. Materials and Methods: A retrospective review was performed of a series of patients who underwent a novel technique of buccal graft placement during an augmented anastomotic urethroplasty. In these cases a ventrally placed buccal graft was quilted to a double layered vest-like closure of the bulbospongiosus muscle. Six cases in total were performed by a single surgeon at a tertiary academic center between 2008 and 2012 and outcomes were reviewed. IRB approval was attained for the study. Results: Mean stricture length was 7.3cm and median follow up was 2 years and 2 months with a range from 3 months to 12 years. Mean postoperative flow rates in short term follow up were 37ml/s and long term follow up 27.6ml/s. Three patients required no further intervention, two underwent dilation at 9 and 12 years postoperatively and one required redo urethroplasty. Conclusions: This new technique of using quilting a ventrally placed buccal graft to double layered bulbospongiosus muscle backing during anastomotic urethroplasty for long partially obliterative urethral strictures shows potential and warrants further study.
| Published in | International Journal of Clinical Urology (Volume 6, Issue 1) |
| DOI | 10.11648/j.ijcu.20220601.18 |
| Page(s) | 30-33 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2022. Published by Science Publishing Group |
Urethral Stricture, Augmented Anastomotic Urethroplasty, Ventral Onlay Buccal Graft, Bulbospongiosus Muscle Flap
| [1] | Barbagli G, Guazzoni G, Lazzeri M. One-stage bulbar urethroplasty: retrospective analysis of the results in 375 patients. Eur Urol 2008; 53: 828-833. |
| [2] | Heinke T, Gerharz EW, Bonfig R, Riedmiller H. Ventral onlay urethroplasty using buccal mucosa for complex stricture repair. Urology 2003; 61: 1004-1007. |
| [3] | Markiewicz MR, Lukose MA, Margarone JE, 3rd et al. The oral mucosa graft: a systematic review. J Urol 2007; 178: 387-394. |
| [4] | Zinman L. Optimal management of the 3- to 6-centimeter anterior urethral stricture. Curr Urol Rep 2000; 1: 180-189. |
| [5] | Levy ME, Elliott SP. Graft Use in Bulbar Urethroplasty. Urol Clin North Am. 2017; 44 (1): 39-47. |
| [6] | Horiguchi A. Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews. Int J Urol. 2017; 24 (7): 493-503. |
| [7] | Wessells H, McAninch JW. Current controversies in anterior urethral stricture repair: free-graft versus pedicled skin-flap reconstruction. World J Urol 1998; 16: 175-180. |
| [8] | Filipas D, Fisch M, Fichtner J et al. The histology and immunohistochemistry of free buccal mucosa and full-skin grafts after exposure to urine. BJU Int 1999; 84: 108-111. |
| [9] | Soliman MG, Abo Farha M, El Abd AS et al. Dorsal onlay urethroplasty using buccal mucosa graft versus penile skin flap for management of long anterior urethral strictures: a prospective randomized study. Scand J Urol 2014; 48: 466-473. |
| [10] | Warner JN, Malkawi I, Dhradkeh M, Joshi PM, Kulkarni SB, Lazzeri M, Barbagli G, Mori R, Angermeier KW, Storme O, Campos R, Velarde L, Gomez RG, Han JS, Gonzalez CM, Martinho D, Sandul A, Martins FE, Santucci RA. A Multi-institutional Evaluation of the Management and Outcomes of Long-segment Urethral Strictures. Urology. 2015; 85 (6): 1483-7. |
| [11] | Mellon MJ, Bihrle R. Ventral onlay buccal mucosa urethroplasty: a 10-year experience. Int J Urol 2014; 21: 190-193. |
| [12] | Barbagli G, Kulkarni SB, Fossati N, Larcher A, Sansalone S, Guazzoni G, Romano G, Pankaj JM, Dell'Acqua V, Lazzeri M. Long-term followup and deterioration rate of anterior substitution urethroplasty. J Urol. 2014; 192 (3): 808-13. |
| [13] | Rogers HS, McNicholas TA, Blandy JP. Long-term results of one-stage scrotal patch urethroplasty. Br J Urol 1992; 69: 621-628. |
| [14] | Fichtner J, Filipas D, Fisch M et al. Long-term outcome of ventral buccal mucosa onlay graft urethroplasty for urethral stricture repair. Urology 2004; 64: 648-650. |
APA Style
Susan MacDonald, Nathan Michalak, Ross Decter. (2022). Vest-like Closure of Bulbospongiosus Muscle Flap During Augmented Anastomotic Urethroplasty. International Journal of Clinical Urology, 6(1), 30-33. https://doi.org/10.11648/j.ijcu.20220601.18
ACS Style
Susan MacDonald; Nathan Michalak; Ross Decter. Vest-like Closure of Bulbospongiosus Muscle Flap During Augmented Anastomotic Urethroplasty. Int. J. Clin. Urol. 2022, 6(1), 30-33. doi: 10.11648/j.ijcu.20220601.18
AMA Style
Susan MacDonald, Nathan Michalak, Ross Decter. Vest-like Closure of Bulbospongiosus Muscle Flap During Augmented Anastomotic Urethroplasty. Int J Clin Urol. 2022;6(1):30-33. doi: 10.11648/j.ijcu.20220601.18
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Download@article{10.11648/j.ijcu.20220601.18,
author = {Susan MacDonald and Nathan Michalak and Ross Decter},
title = {Vest-like Closure of Bulbospongiosus Muscle Flap During Augmented Anastomotic Urethroplasty},
journal = {International Journal of Clinical Urology},
volume = {6},
number = {1},
pages = {30-33},
doi = {10.11648/j.ijcu.20220601.18},
url = {https://doi.org/10.11648/j.ijcu.20220601.18},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcu.20220601.18},
abstract = {Introduction: Long urethral strictures with an obliterative segment remain a technical challenge when attempting a durable operative repair. An augmented anastomotic urethroplasty using buccal mucosa is typically performed in these cases, but the ideal position of the buccal graft is still under debate. Materials and Methods: A retrospective review was performed of a series of patients who underwent a novel technique of buccal graft placement during an augmented anastomotic urethroplasty. In these cases a ventrally placed buccal graft was quilted to a double layered vest-like closure of the bulbospongiosus muscle. Six cases in total were performed by a single surgeon at a tertiary academic center between 2008 and 2012 and outcomes were reviewed. IRB approval was attained for the study. Results: Mean stricture length was 7.3cm and median follow up was 2 years and 2 months with a range from 3 months to 12 years. Mean postoperative flow rates in short term follow up were 37ml/s and long term follow up 27.6ml/s. Three patients required no further intervention, two underwent dilation at 9 and 12 years postoperatively and one required redo urethroplasty. Conclusions: This new technique of using quilting a ventrally placed buccal graft to double layered bulbospongiosus muscle backing during anastomotic urethroplasty for long partially obliterative urethral strictures shows potential and warrants further study.},
year = {2022}
}
TY - JOUR T1 - Vest-like Closure of Bulbospongiosus Muscle Flap During Augmented Anastomotic Urethroplasty AU - Susan MacDonald AU - Nathan Michalak AU - Ross Decter Y1 - 2022/02/25 PY - 2022 N1 - https://doi.org/10.11648/j.ijcu.20220601.18 DO - 10.11648/j.ijcu.20220601.18 T2 - International Journal of Clinical Urology JF - International Journal of Clinical Urology JO - International Journal of Clinical Urology SP - 30 EP - 33 PB - Science Publishing Group SN - 2640-1355 UR - https://doi.org/10.11648/j.ijcu.20220601.18 AB - Introduction: Long urethral strictures with an obliterative segment remain a technical challenge when attempting a durable operative repair. An augmented anastomotic urethroplasty using buccal mucosa is typically performed in these cases, but the ideal position of the buccal graft is still under debate. Materials and Methods: A retrospective review was performed of a series of patients who underwent a novel technique of buccal graft placement during an augmented anastomotic urethroplasty. In these cases a ventrally placed buccal graft was quilted to a double layered vest-like closure of the bulbospongiosus muscle. Six cases in total were performed by a single surgeon at a tertiary academic center between 2008 and 2012 and outcomes were reviewed. IRB approval was attained for the study. Results: Mean stricture length was 7.3cm and median follow up was 2 years and 2 months with a range from 3 months to 12 years. Mean postoperative flow rates in short term follow up were 37ml/s and long term follow up 27.6ml/s. Three patients required no further intervention, two underwent dilation at 9 and 12 years postoperatively and one required redo urethroplasty. Conclusions: This new technique of using quilting a ventrally placed buccal graft to double layered bulbospongiosus muscle backing during anastomotic urethroplasty for long partially obliterative urethral strictures shows potential and warrants further study. VL - 6 IS - 1 ER -
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