Treatment of urethral strictures using buccal mucosa graft. A single group experience

Antonio Ruffo1, Francesco Trama2, Leo Romis1, Giovanni Di Lauro1, Giuseppe Romeo2, Fabrizio Iacono2
  • 1 Ospedale Santa Maria delle Grazie (Pozzuoli)
  • 2 Università di Napoli Federico II (Napoli)

Objective

Urethral stricture is complex urological disease characterized by a narrowing of the urethral lumen. These conditions affects patients psychologically too having a severe impact on health and quality of life of these patients. Management of urethral strictures is difficult and requires careful evaluation. There are different treatment options for urethral stricture. Urethral dilation and internal urethrotomy represent the most commonly performed procedures but they have very low success rate.. Urethroplasty has a much higher chance of success (85-90%) and is considered the gold-standard treatment. Buccal mucosa seems to be the best graft for uretroplasty [1].

Materials and Methods

In this study 20 patients (pts) were enrolled : 2 pts with penile stricture, 3 pts with penile stricture and failed hypospadia repair, 1 pt penile stricture with lichen sclerosus and failed hypospadia repair, 14 pts with bulbar stricture. Median age was 51 years.
Stricture etiology was idiopathic, failed hypospadias and flogistic. All pts underwent previous surgery. 2 pts had sovrapubic catheter.
1 patient with failed hypospadia and lichen sclerosus underwent 2 stages uretroplasty (2 stage at six months after the first surgery).
Average stricture length was 3.2 cm.
All patient underwent preoperatively evaluation using : uroflowmetry , retrograde urethrography, ultrasound, cystoscopy. Maximum flow rate (Qmax) and post-void residual urine were collected before surgery and at 3 and 6 months follow-up.

Results

All patients were very satisfied with the result of the surgery.
In 2 pts (10%) a second surgery was needed in order to dilate the urethral lumen endoscopically.
At 6 months follow-up the mean Qmax increased from 4.64mL/s to 21mL/s at 6 months follow-up.
Mean post-void residual urine was 48 mL.

Discussions

The use of buccal mucosa graft urethroplasty for bulbar urethral strictures has gained widespread popularity since the first report in 1996 [2].
Buccal mucosa seems to be the ideal tissue to reconstruct the urethra. Regarding bulbar strictures, the best approach for the placement of the graft remains controversial.
Medium- and long-term outcomes of all three approaches were comparable ranging between 80 and 88% [3].
For failed hypospadia patients with concomitant uretral strictures the management seems to be more complex due the number of previous surgeries starting from pediatric age.

Conclusion

In our opinion uretroplasty is the only procedures that provides satisfying results. Uretrotomy is suggested in naive pts with strictures < 1 cm with a success rate of 30%.
End-to-end anastomosis is valid with short strictures or in posterio strictures.
At the state of art, buccal mucosa is still the best graft for long strictures affecting the urethra.

Argomenti: