Dorsal onlay graft urethroplasty using penile skin or buccal mucosa for repair of bulbar urethral stricture: results of a prospective single center study.
OBJECTIVE
To compare the outcomes of dorsal onlay graft urethroplasty using penile skin (PS) or buccal mucosa (BM) free grafts in the repair of adult bulbourethral strictures.


METHODS
From January 1998 to March 2003, 30 patients with bulbar urethral strictures underwent urethral reconstruction with PS (17) or with BM free graft (13). Follow-up was done at 6, 12 and 18 months postoperatively, and every year subsequently. Success was defined as normalization of IPSS and a stable Q(max) value >20 ml/s. Any further instrumentation for stricture recurrence was considered a failure.


RESULTS
Mean follow-up was 51 months (20-74). The overall success rate was 80% (85% in the BM and 76% in the PS group). Improvement of uroflowmetry, IPSS and QoL did not show a significant difference between the two groups. A significant improvement of the orgasmic function domain of the IIEF was found in patients treated with a PS graft. Post-operative complications were lip hypoesthesia (30%), retraction of the ventral skin of the penis (7%), post-voiding dribbling (8% with BM graft, and 7%, with PS graft). Six patients, 2 with BM (15%) and 4 with PS graft patch (24%) required further treatment due to stricture recurrence.


CONCLUSIONS
Results of PS or BM graft are comparable at 18 month follow-up, although orgasmic function is significantly improved in patients receiving a PS graft. Nevertheless, with extended follow-up, the use of PS seems to be associated with a higher failure rate.
Raber
Marco
M
Department of Urology, University Vita Salute San Raffaele, Milan, Italy.
Naspro
Richard
R
Scapaticci
Emanuele
E
Salonia
Andrea
A
Scattoni
Vincenzo
V
Mazzoccoli
Bruno
B
Guazzoni
Giorgio
G
Rigatti
Patrizio
P
Montorsi
Francesco
F
D000328:Adult; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D010413:Penis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016038:Skin Transplantation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000175:diagnosis* / Q000601:surgery*; D014554:Urination / Q000502:physiology; D014563:Urodynamics; D013521:Urologic Surgical Procedures, Male / Q000379:methods