Ventral onlay urethroplasty using buccal mucosa for complex stricture repair.
OBJECTIVE
To report the short to medium-term results of one-stage buccal mucosa ventral onlay in the treatment of recurrent urethral stricture disease.


METHODS
Between April 1997 and July 2001, buccal mucosa was used as a ventral onlay graft in 38 patients with recurrent strictures of the bulbar (n = 30) and proximal penile urethra (n = 8). All patients had undergone at least 1 urethrotomy (range 1 to 10; mean 2.9) before reconstruction. Prospective follow-up included a simple questionnaire on patient satisfaction, uroflowmetry, and ultrasound estimation of postvoid residual urine volume and, in the case of recurrence, retrograde urethrography and cystoscopy.


RESULTS
The primary success rate at a mean follow-up of 22.8 months (range 8.7 to 40.7) was 80%. Stricture recurred in 7 patients, mostly within 12 months. A distinct residual irregularity at the former stricture site in the initial postoperative urethrogram was predictive of failed reconstruction. A second procedure was performed in 4 patients (1 urethrotomy and 3 re-buccal mucosa onlay grafts) with good results. Patient satisfaction was high in most instances. Three patients refused reoperation, preferring regular intermittent dilation.


CONCLUSIONS
When end-to-end anastomosis is impossible, onlay urethroplasty using buccal mucosa is a rather simple alternative with encouraging short to medium-term results in the proximal segments of the male urethra.
Department of Urology, Julius-Maximilians University Medical School, Würzburg, Germany.
Tobias
T
Heinke
Elmar W
EW
Gerharz
Roland
R
Bonfig
Hubertus
H
Riedmiller
D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000601:surgery / Q000637:transplantation*; D017060:Patient Satisfaction; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012086:Reoperation; D011795:Surveys and Questionnaires; D014182:Transplantation, Autologous; D017211:Treatment Failure; D016312:Treatment Refusal; D014525:Urethral Stricture / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*