Urethroplasty for high-risk, long segment urethral strictures with ventral buccal mucosa graft and gracilis muscle flap - Abstract

PURPOSE: Long-segment urethral strictures with a compromised graft bed and poor vascular supply are unfit for standard repair, and are at high-risk for stricture recurrence.

Our objective was to assess the success of urethral reconstruction in these patients with a ventral buccal mucosa graft (BMG) and gracilis muscle flap (GMF).

MATERIALS AND METHODS: A retrospective review of 1039 patients who underwent urethroplasty at Lahey Hospital and Medical Center between 1999 and 2014 was performed. We identified 20 patients who underwent urethroplasty with a ventral BMG and GMF graft bed. Stricture recurrence was defined as the inability to pass a 16 Fr cystoscope.

RESULTS: Mean stricture length was 8.2 cm (3.5-15). Strictures were located in the posterior urethra with or without involvement of the bulbar urethra in 50%, bulbomembranous urethra (35%), bulbar urethra (10%), and proximal pendulous urethra (5%). Stricture etiology was radiation therapy in 45% followed by idiopathic (20%), trauma (15%), prostatectomy (10%), hypospadias failure (5%), and transurethral surgery (5%). 9 patients (45%) had previous urethroplasty and 3 (15%) had previous UroLume® stents. Urethral reconstruction was successful in 16 patients (80%), with a mean follow-up of 40 months. Of the failures, one patient had an ileal loop, two a suprapubic tube, and one urethral dilation. Mean time to recurrence was 10 months (2-17). 5 patients (25%) had postoperative incontinence requiring an artificial urinary sphincter.

CONCLUSIONS: Urethroplasty for high-risk, long segment urethral strictures can be successfully performed with a ventral BMG and GMF avoiding urinary diversion in the majority of patients.

Written by:
Palmer DA, Buckley JC, Zinman LN, Vanni AJ.   Are you the author?
Lahey Hospital & Medical Center, Burlington, MA; University of California, San Diego, CA.  

Reference: J Urol. 2014 Sep 24. pii: S0022-5347(14)04546-7.
doi: 10.1016/j.juro.2014.09.093


PubMed Abstract
PMID: 25261802

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