title: Versatility of the ventral approach in bulbar urethroplasty using dorsal, ventral or dorsal plus ventral oral grafts.
abstract: OBJECTIVE
  To investigate the versatility of the ventral urethrotomy approach in bulbar reconstruction with buccal mucosa (BM) grafts placed on the dorsal, ventral or dorsal plus ventral urethral surface.
  
  
  METHODS
  Between 1999 and 2008, 216 patients with bulbar strictures underwent BM graft urethroplasty using the ventral-sagittal urethrotomy approach. Of these patients, 32 (14.8%; mean stricture 3.2 cm, range 1.5-5) had a dorsal graft urethroplasty (DGU), 121 (56%; mean stricture 3.7, range 1.5-8) a ventral graft urethroplasty (VGU), and 63 (29.2%; mean stricture 3.4, range 1.5-10) a dorsal plus ventral graft urethroplasty (DVGU). The strictured urethra was opened by a ventral-sagittal urethrotomy and BM graft was inserted dorsally or ventrally or dorsal plus ventral to augment the urethral plate.
  
  
  RESULTS
  The median follow-up was 37 months. The overall 5-year actuarial success rate was 91.4%. The 5-year actuarial success rates were 87.8%, 95.5% and 86.3% for the DGU, VGU and DVGU, respectively. There were no statistically significant differences among the three groups. Success rates decreased significantly only with a stricture length of >4 cm.
  
  
  CONCLUSIONS
  In BM graft bulbar urethroplasties the ventral urethrotomy access is simple and versatile, allowing an intraoperative choice of dorsal, ventral or combined dorsal and ventral grafting, with comparable success rates.
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, University Federico II, Naples, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Fusco
authors.affiliation: Department of Urology, Sant'Andrea Hospital, 'La Sapienza' University, Rome, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
authors.affiliation: Urology Department, Patras University Hospital, Patras, Greece.
authors.forename: Kostas
authors.initials: K
authors.lastname: Giannitsas
authors.affiliation: Urology & Nephrology Center, Mansoura, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Shokeir
keywords: (D)(V)(DV)GU, (dorsal) (ventral) (dorsal plus ventral) graft urethroplasty; AU, anastomotic urethroplasty; BM, buccal mucosa; Buccal mucosa; Graft; Stricture; Urethra; Urethroplasty; VCUG, voiding cysto-urethrography