Combined dorsal plus ventral double buccal mucosa graft in bulbar urethral reconstruction.
OBJECTIVE
We describe a technique for bulbar urethral reconstruction using a combined dorsal plus ventral double buccal mucosa graft (BMG).


METHODS
From March 2002 to June 2006, 48 men, mean age 35 yr, with bulbar strictures underwent patch urethroplasty using a dorsal plus a ventral double BMG. Average stricture length was 3.65 cm (range: 2-10 cm). The stenotic urethral segment was opened along its ventral surface; the exposed dorsal urethra was incised in the midline to create an elliptical area over the tunica albuginea where the dorsal inlay BMG was placed and quilted to the corpora to augment dorsally the urethral plate. Subsequently, the ventral onlay BMG was sutured to the urethral lateral margins to complete the augmented urethroplasty. Finally, the spongiosum was closed over the graft. Successful reconstruction was defined as normal voiding without the need for any postoperative procedure including dilation.


RESULTS
Mean follow-up was 22 mo (range: 13-59 mo). At the catheter removal 3 wk after surgery, in three patients the voiding cystourethrography showed a fistula, which recovered after a prolonged catheterization. Of 48 cases, 43 (89.6%) were successful and 5 (10.4%) failures with recurrence of the stricture; 4 were treated with internal urethrotomy and 1 with a temporary perineal urethrostomy.


CONCLUSIONS
Preliminary results with a combined double BMG urethroplasty for severe bulbar stricture are encouraging. The double dorsal and ventral graft may provide a simple and reliable solution to achieve an adequate urethral lumen in selected patients.
Palminteri
Enzo
E
Center for Urethral and Genitalia Reconstructive Surgery, Arezzo, Italy. enzo.palminteri@inwind.it
Manzoni
Gianantonio
G
Berdondini
Elisa
E
Di Fiore
Francesco
F
Testa
Gianfranco
G
Poluzzi
Maurizio
M
Molon
Angelo
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D014567:Urography; D013521:Urologic Surgical Procedures, Male / Q000379:methods*