title: Substitution urethroplasty of complex and long-segment urethral strictures: a rationale for procedure selection.
abstract: OBJECTIVE
  We evaluated the applications and outcomes of substitution urethroplasty, using a variety of techniques, in 65 patients with complex, long-segment urethral strictures.
  
  
  METHODS
  From January 1995 to December 2005, 65 patients with complex urethral strictures >8cm in length underwent substitution urethroplasty. Of the 65 patients, 43 underwent one-stage urethral reconstruction using mucosal grafts (28 colonic mucosal graft, 12 buccal mucosal graft, and 3 bladder mucosal graft), 17 patients underwent one-stage urethroplasty using pedicle flaps, and 5 patients underwent staged Johanson's urethroplasty.
  
  
  RESULTS
  The mean follow-up time was 4.8 yr (range; 0.8-10 yr), with an overall success rate of 76.92% (50 of 65 cases). Complications developed in 15 patients (23.08%) and included recurrent stricture in 7 (10.77%), urethrocutaneous fistula in 3 (4.62%), coloabdominal fistula in 1 (1.54%), penile chordee in 2 (3.08%), and urethral pseudodiverticulum in 2 (3.08%). Recurrent strictures and urethral pseudodiverticulum were treated successfully with a subsequent procedure, including repeat urethroplasty in six cases and urethrotomy or dilation in three. Coloabdominal fistula was corrected only by dressing change; five patients await further reconstruction.
  
  
  CONCLUSIONS
  Penile skin, colonic mucosal, and buccal mucosal grafts are excellent materials for substitution urethroplasty. Colonic mucosal graft urethroplasty is a feasible procedure for complicated urethral strictures involving the entire or multiple portions of the urethra and the technique may also be considered for urethral reconstruction in patients in whom other conventional procedures failed.
authors.affiliation: Department of Urology, Sixth People's Hospital, Jiaotong University of Shanghai, Shanghai 200233, People's Republic of China. xuyuemin@263.net
authors.forename: Yue-Min
authors.initials: YM
authors.lastname: Xu
authors.forename: Yong
authors.initials: Y
authors.lastname: Qiao
authors.forename: Ying-Long
authors.initials: YL
authors.lastname: Sa
authors.forename: Den-Long
authors.initials: DL
authors.lastname: Wu
authors.forename: Xin-Ru
authors.initials: XR
authors.lastname: Zhang
authors.forename: Jion
authors.initials: J
authors.lastname: Zhang
authors.forename: Bao-Jun
authors.initials: BJ
authors.lastname: Gu
authors.forename: San-Bao
authors.initials: SB
authors.lastname: Jin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods