title: Two-sided urethra-sparing reconstruction combining dorsal preputial skin plus ventral buccal mucosa grafts for tight bulbar strictures.
abstract: OBJECTIVE
  To report our initial experience with urethra-sparing reconstruction combining dorsal preputial skin and ventral buccal mucosa grafts for tight bulbar urethral strictures.
  
  
  METHODS
  Between November 2006 and September 2012, 26 patients with tight bulbar strictures underwent urethroplasty. Using a ventral urethrotomy approach, the two-sided urethral reconstruction was carried out avoiding the transection of urethra and augmenting the preserved urethral plate by dorsal preputial skin plus ventral buccal mucosa grafts. The primary outcome was the objective urinary result, defined as the absence of stricture recurrence. The outcome was considered a failure when any postoperative instrumentation was required. Postoperative sexual dysfunctions were investigated using a validated questionnaire.
  
  
  RESULTS
  Mean follow up was 30.1 months (range 12-79 months). Mean stricture length was 3.3 cm (range 1.5-6 cm). Mean length for dorsal preputial skin and ventral buccal mucosa grafts was 3.2 cm (range 2-7 cm) and 4.9 cm (range 4-6 cm), respectively. Of 26 cases, 23 (88.5%) were successful and three (11.5%) were failures with stricture recurrence. Failures were treated with perineal urethrostomy in one case, ventral buccal graft urethroplasty in one case and internal urethrotomy in one case. Among 12 sexually active men preoperatively, none reported postoperative penile curvature/shortening, impaired erection or dissatisfaction regarding erection; sexual activity was unaltered pre- and post-surgery.
  
  
  CONCLUSIONS
  In tight bulbar urethra strictures, the two-sided urethroplasty combining dorsal preputial skin and ventral buccal mucosa grafts provides a safe and effective semi-circumferential reconstruction by augmenting the preserved urethral plate, with no impact on sexual function.
authors.affiliation: Center for Urethral and Genitalia Reconstructive Surgery, Arezzo, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Palminteri
authors.affiliation: Center for Urethral and Genitalia Reconstructive Surgery, Arezzo, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Berdondini
authors.affiliation: Department of Urology, Tor Vergata University, Rome, Italy.
authors.forename: Mirko
authors.initials: M
authors.lastname: Florio
authors.affiliation: Department of Urology, Clinica Cellini, Humanitas Institute, Torino, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Cucchiarale
authors.affiliation: Department of Urology, Clinica Cellini, Humanitas Institute, Torino, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Milan
authors.affiliation: Department of Urology, Clinica Cellini, Humanitas Institute, Torino, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Valentino
authors.affiliation: Department of Urology, "Le Molinette" University, Torino, Italy.
authors.forename: Omid
authors.initials: O
authors.lastname: Sedigh
authors.affiliation: Department of Obstetrics, Gynecology and Urology, 'Sapienza' University, Rome, Italy.
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Di Pierro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D059351:Organ Sparing Treatments; D010413:Penis; D012008:Recurrence; D012086:Reoperation; D060728:Reproductive Health; D012189:Retrospective Studies; D019529:Sexuality; D016038:Skin Transplantation; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D014525:Urethral Stricture / Q000473:pathology / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D055815:Young Adult
keywords: buccal mucosa graft; bulbar urethral stricture; outcomes; preputial skin graft; urethroplasty