Buccal mucosa urethroplasty for adult urethral strictures

Abstract

Urethral strictures are difficult to manage. Some treatment modalities for urethral strictures are fraught with high patient morbidity and stricture recurrence rates; however, an extremely useful tool in the armamentarium of the Reconstructive Urologist is buccal mucosal urethroplasty. We like buccal mucosa grafts because of its excellent short and long-term results, low post-operative complication rate, and relative ease of use. We utilize it for most our bulbar urethral stricture repairs and some pendulous urethral stricture repairs, usually in conjunction with a first-stage Johanson repair. In this report, we discuss multiple surgical techniques for repair of urethral stricture disease. Diagnosis, evaluation of candidacy, surgical techniques, post-operative care, and complications are included. The goal is to raise awareness of buccal mucosa grafting for the management urethral stricture disease.

Keywords: Buccal mucosa; graft; urethral strictures; urethroplasty.

Figure 1

The mouth is marked about 1 cm proximal to lip border. Subsequently, incised with a 15 blade scalpel and dissected off of the buccinator muscle

Figure 2

Buccal harvest site following removal of the graft. Care is taken to avoid Stensen's duct during dissection

Figure 3

Closure of buccal harvest site with a running 3-O chromic stitch

Figure 4

Buccal mucosa graft is prepared by removing excess fat and muscle prior to implantation

Figure 5

The native urethra is incised the entire length of the stricture and prepared to accept the buccal mucosa graft

Figure 6

Buccal graft being sewn to urethral plate using a 5-O polydioxanone suture locking every third stitch for a watertight closure

Figure 7

Closure of bulbocavernsous muscle with a running 3-O polyglactin suture

Figure 8

First-stage Johanson with buccal mucosa augmentation

Figure 9

First-stage Johanson following buccal mucosa graft and 6 months of healing