COMBINED DOUBLE BUCCAL MUCOSA GRAFT IN BULBAR URETHRAL RECONSTRUCTION

Introduction
This is a new surgical technique for bulbar urethral reconstruction using a combined dorsal plus ventral double buccal mucosa graft.

Methods
From March 2002 to June 2006, 48 men (average age 35 years) with bulbar strictures underwent patch urethroplasty using a dorsal plus a ventral double buccal mucosa graft. The average stricture length was 3.65 cm (range 2 to 10).
The stenotic urethral segment was opened along its ventral surface; the exposed dorsal urethra was incised in the midline to create an elliptical area over the tunica albuginea where the dorsal-inlay buccal mucosa graft was placed and quilted to the corpora to augment the urethral plate dorsally. Subsequently, the ventral-onlay buccal mucosa graft was sutured to the urethral lateral margins to complete the augmented urethroplasty. Finally, the spongiosum was closed over the graft. The successful reconstruction was defined as normal voiding without the need for any postoperative procedure including dilation.

Results
Mean follow up was 22 months (range 13 to 59). At catheter removal 3 weeks after surgery, in 3 patients the voiding cystourethrography showed a fistula which recovered by a prolonged catheterization. 43 cases out of 48 (89.6 %) were successful and 5 (10.4 %) failures occurred with recurrence of the stricture: 4 were treated with internal urethrotomy and 1 with a temporary perineal urethrostomy.

Conclusions
Preliminary results with a combined double buccal mucosa graft urethroplasty for severe bulbar stricture are encouraging. The double dorsal and ventral graft may provide a simple and reliable solution to achieve an adequate urethral lumen in selected patients.
Disclamer
Caution! Surgical images