title: Two-sided dorsal plus ventral oral graft bulbar urethroplasty: long-term results and predictive factors.
abstract: OBJECTIVE
  To evaluate long-term outcomes of the 2-sided dorsal plus ventral oral graft (DVOG) urethroplasty by preserving the narrow urethral plate in tight bulbar strictures and investigate which factors might influence long-term outcomes.
  
  
  METHODS
  This is a single-center retrospective study of 166 patients who underwent DVOG urethroplasty for tight bulbar strictures by a single surgeon (E.P.) between 2002 and 2013. The strictured urethra was opened ventrally; the exposed urethral plate was incised in the midline and augmented dorsally and ventrally using 2 oral grafts. Outcome was considered a failure when any postoperative instrumentation was needed. According to stricture length, patients were classified in 3 groups as follows: ≤1.5 cm (group 1), >1.5 and ≤3.9 cm (group 2), and ≥4 cm (group 3). Time to failure was analyzed using Kaplan-Meier estimates and Cox regression.
  
  
  RESULTS
  Median follow-up was 47 months (interquartile range, 33-95.5 months). Of the 166 patients, 149 (89.8%) were successful and 17 (10.2%) were failures. Most of the failures (90%) were observed during the first 5 years of follow-up; afterward, the success rate remained stable. The stricture length was a significant predictor of surgical outcome (odds ratio, 1.743 per cm; confidence interval, 1.2-2.5; P <.001); patients with a urethral stricture ≥4 cm presented a higher risk of late failure. Age, stricture etiology, and previous treatment were not significant predictors of surgical outcome.
  
  
  CONCLUSIONS
  With long-term follow-up, the treatment of tight bulbar strictures using a 2-sided DVOG urethroplasty showed a high success rate. The stricture length is an independent predictor of failure.
authors: Center for Urethral and Genitalia Reconstructive Surgery, Arezzo, Italy. Electronic address: enzo.palminteri@inwind.it.
authors: Enzo
authors: E
authors: Palminteri
authors: Department of Urology, Ghent University Hospital, Ghent, Belgium.
authors: Nicolaas
authors: N
authors: Lumen
authors: Center for Urethral and Genitalia Reconstructive Surgery, Arezzo, Italy.
authors: Elisa
authors: E
authors: Berdondini
authors: Department of Obstetrics, Gynecology and Urology, 'Sapienza' University, Rome, Italy.
authors: Giovanni Battista
authors: GB
authors: Di Pierro
authors: Department of Urology, Clinica Cellini, Humanitas Institute, Torino, Italy.
authors: Giuseppina
authors: G
authors: Cucchiarale
authors: Centro Chirurgico Toscano, Arezzo, Italy.
authors: Giulia
authors: G
authors: Tenti
authors: Department of Urology, Ospedale Sant'Andrea, 'Sapienza' University, Rome, Italy.
authors: Cosimo
authors: C
authors: De Nunzio
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D014525:Urethral Stricture / Q000473:pathology* / Q000601:surgery*