title: Pseudospongioplasty using periurethral vascularized tissue to support ventral buccal mucosa grafts in the distal urethra.
abstract: OBJECTIVE
  For ventral buccal mucosa graft onlay during bulbar urethroplasty, spongioplasty with advancement and closure of the corpus spongiosum is ordinarily performed to stabilize the graft. In the pendulous and distal bulbar urethra the spongiosum is often too thin to allow complete graft coverage. We describe the results of what to our knowledge is a novel technique for ventral graft coverage using periurethral vascularized tissue. We compared these results to those of conventional spongioplasty.
  
  
  METHODS
  We retrospectively reviewed all urethroplasties performed by 2 surgeons at separate tertiary care facilities from July 2007 to July 2012. One-stage urethroplasties involving ventral buccal mucosa graft placement were selected for analysis. Conventional spongioplasty was performed when possible. When spongiosal tissue was inadequate for graft coverage, periurethral tissue flaps were mobilized bilaterally and sutured together in the midline as pseudospongioplasty to provide coverage. We compared the outcomes of the 2 techniques.
  
  
  RESULTS
  Of 637 urethroplasties performed during the 5-year study period 102 (16%) with a buccal mucosa graft onlay met study inclusion criteria. Pseudospongioplasty was performed in 46 of 102 cases (45%), predominantly in the pendulous urethra (34 of 46 or 74%), with success in 37 of 46 (80%) at a mean followup of 41 months. Conventional spongioplasty had a similar 84% success rate (47 of 56 cases) at a mean followup of 39 months (p = 0.645). For conventional spongioplasty mean stricture length was 4.7 cm compared to 5.8 cm for pseudospongioplasty (p = 0.028).
  
  
  CONCLUSIONS
  Ventral buccal mucosa grafts can be applied reliably to various locations throughout the anterior urethra. For distal grafts, flaps of periurethral tissue provide a suitable host bed for revascularization with results equivalent to those of conventional spongioplasty.
authors.affiliation: Departments of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, and Lenox Hill Hospital (BHC, NAA), New York, New York.
authors.forename: Billy H
authors.initials: BH
authors.lastname: Cordon
authors.affiliation: Departments of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, and Lenox Hill Hospital (BHC, NAA), New York, New York.
authors.forename: Lee C
authors.initials: LC
authors.lastname: Zhao
authors.affiliation: Departments of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, and Lenox Hill Hospital (BHC, NAA), New York, New York.
authors.forename: J Francis
authors.initials: JF
authors.lastname: Scott
authors.affiliation: Departments of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, and Lenox Hill Hospital (BHC, NAA), New York, New York.
authors.forename: Noel A
authors.initials: NA
authors.lastname: Armenakas
authors.affiliation: Departments of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, and Lenox Hill Hospital (BHC, NAA), New York, New York. Electronic address: allen.morey@utsouthwestern.edu.
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D012189:Retrospective Studies; D013524:Surgical Flaps; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D055815:Young Adult
keywords: anatomy; mouth mucosa; surgical flaps; transplants; urethra