title: Buccal mucosal urethroplasty: a versatile technique for all urethral segments.
abstract: OBJECTIVE
  To present our experience with buccal mucosa urethroplasty for substitution of all segments of the anterior urethra, as the buccal mucosal graft (BMG) has emerged as the tissue of choice for single-stage reconstruction of bulbar urethral strictures, but its use for reconstructing meatal, pendulous and pan-urethral strictures has not been widely reported.
  
  
  METHODS
  Between January 1998 and October 2003, 92 patients had a BMG substitution urethroplasty at our institution; 75 had a single-stage dorsal onlay BMG urethroplasty (bulbar 41, pendulous 16 and pan-urethral 18; six combined penile skin flap and BMG) and 17 (pendulous five, pan-urethral 10, bulbar two) a two-stage urethroplasty. Recurrence rates, complications and cosmetic outcomes were analysed retrospectively.
  
  
  RESULTS
  Over a median (range) follow-up of 34 (8-72) months, 66 (88%) patients with a one-stage reconstruction (14/16 pendulous; 37/41, 90%, bulbar; 15/16 pan-urethral) remained stricture-free. The mean (range) time to recurrence was 9.4 (3-17) months. Of the nine recurrent strictures, six were managed by one-stage optical urethrotomy and three required a repeat urethroplasty. In patients who had a staged procedure, after a mean follow-up of 24.2 (9-56) months, one had complete graft loss, requiring re-grafting, five required stomal revision after stage 1, and only two (12%) developed a recurrent stricture after the two-stage urethroplasty.
  
  
  CONCLUSIONS
  A one-stage dorsal onlay BMG urethroplasty provides excellent results for strictures involving any segment of the anterior urethra. The BMG appears to be the most versatile urethral substitute, as it can be successfully used for both one- and two-stage reconstruction of the entire anterior urethra.
authors.affiliation: Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. ddubey@sgpgi.ac.in
authors.forename: Deepak
authors.initials: D
authors.lastname: Dubey
authors.forename: Anant
authors.initials: A
authors.lastname: Kumar
authors.forename: Anil
authors.initials: A
authors.lastname: Mandhani
authors.forename: Aneesh
authors.initials: A
authors.lastname: Srivastava
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kapoor
authors.forename: Mahendra
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; D012086:Reoperation; D012189:Retrospective Studies; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D014548:Urinary Fistula / Q000209:etiology