title: Dorsal onlay buccal mucosa versus penile skin flap urethroplasty for anterior urethral strictures: results from a randomized prospective trial.
abstract: OBJECTIVE
  Reconstructive techniques for anterior urethral strictures have not been subjected to a randomized comparison. In a randomized controlled study we compared outcomes of buccal mucosa dorsal onlay vs skin flap dorsal onlay urethroplasty in patients with complex anterior urethral strictures.
  
  
  METHODS
  In this prospective study 55 patients with anterior urethral strictures were randomized to undergo buccal mucosa dorsal onlay (27) or penile skin flap (28) urethroplasty. Operative time, hospital stay, short and long-term complications, recurrence rates, and patient satisfaction were compared between the 2 groups.
  
  
  RESULTS
  The number of patients with pendulous, bulbar and bulbopendulous strictures as well as mean stricture length and median followup were comparable between the 2 groups. Mean operative time was significantly higher in the penile flap (224 minutes) vs the buccal mucosa group (162 minutes, p = 0.001). In the penile flap group 6 patients had superficial penile skin necrosis, 1 had extensive skin loss and required skin grafting, and 2 had penile torsion. In the buccal mucosa group 25.6% of patients had minor morbidity which settled by 4 weeks after surgery. There were 9 (34.1%) patients in the penile flap group and 4 (14.8%) in the buccal mucosa group (p = 0.001) who had troublesome post-void dribbling. In the buccal mucosa group 89% and in the penile flap group 65% said they would recommend this procedure to another patient (p = 0.001). The success rate in the buccal mucosa (89.9%) and penile flap (85.6%) groups was similar (p >0.05).
  
  
  CONCLUSIONS
  On intermediate followup dorsal onlay penile skin flap and buccal mucosa urethroplasty provide similar success rates. Compared to buccal mucosa, penile flap procedures are technically complex, associated with higher morbidity and less preferred by patients.
authors.affiliation: Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. ddubey@sgpgi.ac.in
authors.forename: Deepak
authors.initials: D
authors.lastname: Dubey
authors.forename: Vivek
authors.initials: V
authors.lastname: Vijjan
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kapoor
authors.forename: Aneesh
authors.initials: A
authors.lastname: Srivastava
authors.forename: Anil
authors.initials: A
authors.lastname: Mandhani
authors.forename: Anant
authors.initials: A
authors.lastname: Kumar
authors.forename: M S
authors.initials: MS
authors.lastname: Ansari
mesh_terms: D000293:Adolescent; 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; D011183:Postoperative Complications / Q000503:physiopathology; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000175:diagnosis / Q000601:surgery*; D014563:Urodynamics; D013521:Urologic Surgical Procedures, Male / Q000379:methods