title: Substitution urethroplasty for anterior urethral strictures: a critical appraisal of various techniques.
abstract: OBJECTIVE
  To retrospectively compare the outcome of various techniques of substitution urethroplasty.
  
  
  METHODS
  Between 1989 and 2000, 109 patients (mean age 39.5 years) underwent substitution urethroplasty for recurrent anterior urethral strictures. Between 1989 and 1995 the procedure was by ventral placement of free grafts (bladder mucosa, buccal mucosa, penile skin) or penile skin flaps. From 1995 onwards the flaps and grafts (buccal mucosa) were applied either ventrally or dorsally. Stricture recurrence and the complications associated with each technique were compared.
  
  
  RESULTS
  Ventral onlay repairs were associated with a higher incidence of complications than dorsal repairs, e.g. postvoid dribbling (39% vs 23%, P = 0.01), ejaculatory dysfunction (20% vs 5%, P = 0.03) and flap/graft pseudo-diverticulum or out-pouching (26% vs 2.6%, P = 0.01). Superficial penile skin necrosis was significantly more common with the use of penile skin flaps than with free grafts. There was no significant difference in stricture recurrence, erectile dysfunction and residual penile deformity among the various techniques.
  
  
  CONCLUSIONS
  Dorsal free graft/flap onlay urethroplasty gives better results than ventrally placed free grafts/flaps. Dorsal onlay buccal mucosal urethroplasty is a versatile procedure and associated with fewer complications than other substitution methods.
authors.affiliation: Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow-226014, India.
authors.forename: D
authors.initials: D
authors.lastname: Dubey
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.forename: P
authors.initials: P
authors.lastname: Bansal
authors.forename: A
authors.initials: A
authors.lastname: Srivastava
authors.forename: R
authors.initials: R
authors.lastname: Kapoor
authors.forename: A
authors.initials: A
authors.lastname: Mandhani
authors.forename: M
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*