Mpilo Central Hospital, Senior Lecturer, School of Medicine, National University of Science and Technology (NUST), P.O. Box 3682, Bulawayo, Zimbabwe.

In the last few decades, many tissues have been used as substitution for long segment urethral strictures. The tissue of choice is still controversial, so new tissues and techniques are continuously being prescribed. The purpose of the present report was to describe the author’s experience with the use of tunica vaginalis (TV) free graft for substitution urethroplasty, along with midterm follow up.

Between October 2005 and November 2008, a total of 20 patients had TV free graft urethroplasty in 2 institutions by the same surgeon [HA]. Patients were assessed preoperative by urethrography. In 8 cases, dorsal urethrotomy was done and the TV graft was placed dorsally and sutured with 3/0 polyglactin running sutures. In 12 cases, complete dissection of the stricture was done; both ends were spatulated, and the TV graft was placed using augmented anastomosis urethroplasty. Urethral stent fixed to a suprapubic catheter was left in situ for 2-4 weeks. The patients were assessed postoperatively by measuring the urine flow rate and by micturating cystourethrography. Follow up ranged from 2 to 38 months. Successful criteria were: patient satisfaction, urine flow rate above 15mL/s, patent urethrogram, and no need for dilation or any instrumentation during the follow-up period.

Out of 20 patients, 1 failed due to severe wound sepsis and the TV was redone successfully 6 months later. One had recurrent urethral stricture 3 months later, managed by optical urethrotomy. The remaining patients (18/20) were voiding well, with an average flow rate >16mL/s. Two developed superficial wound infection that did affect the urethra. None of the patients had any scrotal pain or discomfort in the follow-up period.

This early experience of using tunica vaginalis for substitution urethroplasty has shown encouraging results. The procedure is easy and convenient; donor tissue is obtained through the same incision as the one used for stricture repair. Tunica vaginalis urethroplasty should be considered as an additional option by reconstructive genitourinary surgeons.

Written by:
Ashmawy HM.   Are you the author?

Reference:
UIJ. 2009 Apr;2(2).
doi:10.3834/UIJ.1944-5784.2009.04.07

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