title: Urethroplasty for treatment of long anterior urethral stricture: buccal mucosa graft versus penile skin graft-does the stricture length matter?
abstract: OBJECTIVE
  To investigate the surgical outcomes of dorsal onlay urethroplasty (DOU) using buccal mucosa graft (BMG) or penile skin graft (PSG) and to assess the effect of stricture length in men with anterior urethral strictures.
  
  
  METHODS
  A prospective cohort included men with anterior urethral strictures between 2008 and 2015. Patients underwent DOU using PSG or BMG. Patients had urethrography and uroflowmetry at 0, 3, 6, 12 months, and urethroscopy when needed. Student's t test, Mann-Whitney U tests, and Pearson's Chi-square test were used for analysis.
  
  
  RESULTS
  Sixty-nine patients (43 ± 14 year) were included, 31 received BMG, and 38 received PSG. Mean stricture length was 8 ± 3 cm, mean operative time was 145 ± 31 min, and mean follow-up was 56 ± 10 mo. Success rate was 87 % (90 % BMG vs. 84 % PSG, p = 0.4). Mean operative time was significantly shorter in PSG group (136 ± 29 min vs. 256 ± 58 min, p = 0.0005). Complications of grade I developed in 36 % (wound infection = 10 %, postvoiding dribbling = 18.8 %). Thirty of 69 patients (43 %) had strictures ≥8 cm, and 39 (57 %) had strictures <8 cm-success rate was equal for both subgroups (87 %). Mean blood loss, mean operative time, and incidence of postvoid dribbling were significantly lower in strictures <8 cm.
  
  
  CONCLUSIONS
  BMG and PSG have comparable success rates in treatment of long anterior urethral strictures. Operative time is significantly longer in BMG. Long-segment strictures are associated with longer operative time, more blood loss, and more occurrence of postvoid dribbling. However, the length of the stricture has no influence on the success rate and functional outcomes of DOU.
authors.affiliation: Urology Department, Sohag Faculty of Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt. mmhussein@icloud.com.
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Hussein
authors.affiliation: Urology Department, Sohag Faculty of Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt.
authors.forename: Hazem
authors.initials: H
authors.lastname: Almogazy
authors.affiliation: Urology Department, Sohag Faculty of Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mamdouh
authors.affiliation: Urology Department, Sohag Faculty of Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt.
authors.forename: Fawzy
authors.initials: F
authors.lastname: Farag
authors.affiliation: Urology Department, Sohag Faculty of Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt.
authors.forename: Elnesr
authors.initials: E
authors.lastname: Rashed
authors.affiliation: Urology Department, Sohag Faculty of Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt.
authors.forename: Wael
authors.initials: W
authors.lastname: Gamal
authors.affiliation: Urology Department, Sohag Faculty of Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Rashed
authors.affiliation: Urology Department, Sohag Faculty of Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zaki
authors.affiliation: Urology Department, Sohag Faculty of Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt.
authors.forename: Esam
authors.initials: E
authors.lastname: Salem
authors.affiliation: Urology Department, Sohag Faculty of Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ryad
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D061646:Operative Time; D010413:Penis; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D016038:Skin Transplantation; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000473:pathology* / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods
keywords: Buccal mucosa graft; Dorsal onlay; Penile skin graft; Urethroplasty