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. 2019 May 16;19(1):38.
doi: 10.1186/s12894-019-0466-4.

Outcome of staged buccal mucosal graft for repair of long segment anterior urethral stricture

Mohamed Selim  1 , Shady Salem  1 , Eid Elsherif  1 , Atef Badawy  1 , Mohamed Elshazely  1 , Maher Gawish  2
Affiliations

Outcome of staged buccal mucosal graft for repair of long segment anterior urethral stricture

Mohamed Selim et al. BMC Urol. .

Abstract

Background: Long anterior urethral stricture due to variable etiological factors constitutes a challenge for reconstruction. We evaluated our centers experience with cases of long anterior urethral stricture due to different etiologies that were managed by 2-stage substitution urethroplasty using buccal mucosal graft procedure.

Methods: During the period between November 2009 and November 2016. All cases with long anterior urethral stricture that were planned for substitution urethroplasty in our department were enrolled in this study. The first stage was excision of most fibrotic areas of the urethral plate, the remaining of the urethra is laid open and augmented with buccal mucosal graft for second stage closure after 6-9 months.

Results: The study included 123 patients who underwent first stage, 105 patients of them underwent second stage urethroplasty. Eighteen cases were missed after first stage. The mean (range) age was 38.4 (17-60 years). The mean (range) stricture length was 8.3 (4-13 cm). The cause of stricture was idiopathic in 47, inflammatory in 15, lichen sclerosus in 26 and post failed hypospadias repair in 35 patients. First stage was complicated by graft contracture in 11 (8.9%) patients that needed re-grafting, 5(4.1%) patient had bleeding from the buccal mucosa site that needed haemostatic sutures, oral numbness was reported in 7 (5.7%) patients. Second stage was complicated by wound dehiscence in 2(1.9%) patients, restricture in 11 (10.5%), fistula in 6 (5.7%) patients, meatal stenosis in 3 (2.9%). The overall success rate was 79.1% (83 cases out of 105) with a mean (range) follow-up of 34.7 (10-58 months).

Conclusions: Staged urethroplasty using buccal mucosal graft procedure is an effective surgical option for patients with long anterior urethral strictures especially for patients with lichen sclerosus and those with failed previous surgical repair.

Keywords: Anterior; Staged; Stricture; Urethra.

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Conflict of interest statement

Ethics approval and consent to participate

All participants provided written informed consent to participate in the study, in accordance with the ethical standards of the Institution and/or National Research Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The protocol and the written informed consent were approved by the local ethical committee of each study hospital (Menoufia and Al Azhar University teaching hospitals, Egypt).

Consent for publication

Informed consent was obtained from all the patients. The patient depicted in Figs. 1 and 2 gave a written informed consent to publish the images.

Competing interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a, buccal mucosa graft was tailored and placed beside the marsupialized urethra. 1. b, buccal mucosa was fixed alongside the urethra, penile skin, fenestrated, quilted and urethral catheter was fixed
Fig. 2
Fig. 2
a, Roof strip was mobilized by dissection of the skin at the edge of the strip, one stage buccal mucosal roof strip augmentation of the narrow distal neourethra and urethral catheter.2. b tubularization of the neourethra
See this image and copyright information in PMC

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