title: Augmented perineal urethrostomy using a dorsal buccal mucosal graft, bi-institutional study.
abstract: OBJECTIVE
  To present our technique and outcomes for perineal urethrostomy augmented with a dorsal onlay buccal mucosa graft (BMG). Results from initial series and collaboration from an international center are included.
  
  
  METHODS
  A retrospective chart review of all adult patients who underwent urethral reconstruction with perineal urethrostomy utilizing a buccal mucosal graft between January 1, 2002 and January 1, 2013 was performed. All surgeries were performed by three surgeons using the same technique (GHJ, KAM, and RV). Success was defined as no need for additional treatment following definitive surgery.
  
  
  RESULTS
  A total of 44 patients met inclusion criteria. Mean patient age was 60 (range 44-81) years. All strictures were pananterior. Etiologies included unknown in 16 (36%), failed hypospadias repair in six (14%), lichen sclerosus in ten (23%), iatrogenic in seven (16%), Fournier's in three (7%), urethral cancer in one (2%) and penile cancer in one (2%). Mean follow-up was 45 (range 6-136) months. Overall success was 80%. Nine patients recurred, of which four had a successful revision, two are awaiting potential revision, and three are being managed with periodic dilations.
  
  
  CONCLUSIONS
  BMG perineal urethrostomy is a valid alternative for complex urethral strictures due to lichen sclerosus, previous failed reconstructions or hypospadias cripples. Midterm results are encouraging for this novel technique.
authors.affiliation: Department of Urology, Eastern Virginia Medical School (EVMS), Norfolk, VA, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: DeLong
authors.affiliation: Department of Urology, Eastern Virginia Medical School (EVMS), Norfolk, VA, USA.
authors.forename: Kurt
authors.initials: K
authors.lastname: McCammon
authors.affiliation: Department of Urology, Centro de Educación Medica e Investigaciones Cínicas "Dr. Norberto Quirno" (CEMIC), Buenos Aires, Argentina.
authors.forename: Leandro
authors.initials: L
authors.lastname: Capiel
authors.affiliation: Department of Urology, Centro de Educación Medica e Investigaciones Cínicas "Dr. Norberto Quirno" (CEMIC), Buenos Aires, Argentina.
authors.forename: Augustín
authors.initials: A
authors.lastname: Rovegno
authors.affiliation: Department of Urology, Eastern Virginia Medical School (EVMS), Norfolk, VA, USA.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Tonkin
authors.affiliation: Department of Urology, Eastern Virginia Medical School (EVMS), Norfolk, VA, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Jordan
authors.affiliation: Department of Urology, Eastern Virginia Medical School (EVMS), Norfolk, VA, USA. virasor@evms.edu.|Department of Urology, Centro de Educación Medica e Investigaciones Cínicas "Dr. Norberto Quirno" (CEMIC), Buenos Aires, Argentina. virasor@evms.edu.
authors.forename: Ramón
authors.initials: R
authors.lastname: Virasoro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D010030:Ostomy / Q000379:methods*; D010502:Perineum / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods
keywords: Lichen sclerosis; Oral mucosa graft; Perineal urethrostomy; Urethral stricture