Transurethral ventral buccal mucosa graft inlay for treatment of distal urethral strictures: international multi-institutional experience.

To critically evaluate a multi-institutional patient cohort undergoing single-stage distal urethral repair using a novel transurethral buccal mucosa graft inlay urethroplasty technique (TBMGI).

A retrospective multi-institutional review of consecutive patients with fossa navicularis (FN) strictures treated with a single-stage TBMGI technique at 12 institutions from March 2014-March 2018 was performed. Patient demographics, stricture characteristics, clinical and patient-reported outcomes were analyzed. The primary outcomes were stricture recurrence and complications. Secondary outcomes were change in maximum urinary flow rate (Qmax), PVR, and changes in IPSS, SHIM and global response assessment (GRA) questionnaire responses. Descriptive statistical analysis was used for evaluation of outcomes.

Sixty-eight men met inclusion criteria. Median age and stricture length were 60 years (IQR 48-69) and 2 cm (IQR 2-3), respectively. Most common stricture etiology was lichen sclerosus (34%). Median operative time and EBL were 72 min (IQR 50-120) and 20 mL (IQR 10-43), respectively. Fifty-seven men completed ≥ 12-month follow-up. At a median follow-up of 17 months (IQR 13-22), 54 patients (95%) remained stricture-free. Median Qmax improved from 5 to 18 mL/s (p < 0.0001), PVR 76-21 mL (p < 0.0001), and IPSS 15-5 (p < 0.0001); IPSS-QOL score: 5-1 (p < 0.0001). SHIM score did not significantly change following repair (median 22-21 p = 0.85). On GRA assessment, a majority of men reported "marked" (64%) or "moderate" (28%) overall improvement. No patient developed fistula, glanular dehiscence, graft necrosis or chordee.

This novel minimally invasive transurethral urethroplasty technique is feasible and has demonstrated generalizable outcomes in a multi-institutional cohort with varying etiologies.

World journal of urology. 2020 Jan 01 [Epub ahead of print]

Michael Daneshvar, Jay Simhan, Stephen Blakely, Javier C Angulo, Jacob Lucas, Craig Hunter, Justin Chee, Damian Lopez Alvarado, Erick Alejandro Ramirez Perez, Alosh Madala, Juan José de Benito, Francisco Martins, João Felício, Paul Rusilko, Brian J Flynn, Dmitriy Nikolavsky

Department of Urology, SUNY Upstate Medical University, Syracuse, NY, 13078, USA., Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA., Departamento Clinico, Facultad de Ciencias Biomedicas Y de La Salud, Universidad Europea de Madrid, Laureate Universitites, Madrid, Spain., University of Nevada, Reno, NV, USA., Murac Health, Melbourne, Australia., Hospital Regional Lic. Adolfo Lopez Mateos, Mexico City, Mexico., Hospital Angeles Mocel, Mexico City, Mexico., Ascension Health, Wichita, KS, USA., Sanatorio Allende, Córdoba, Argentina., University of Lisbon, Hospital Santa Maria, Lisbon, Portugal., University of Pittsburgh, Pittsburgh, PA, USA., University of Colorado, Aurora, CO, USA., Department of Urology, SUNY Upstate Medical University, Syracuse, NY, 13078, USA. .