Two-Staged Urethroplasty: Buccal Mucosa and Mesh Graft Techniques

Abstract

Purpose: The purpose of this study was to describe indications, the operative technique and results of the two-staged buccal mucosa (BM) and mesh graft urethroplasty for treatment of ­urethral strictures. Material and Methods: Between 3 / 1993 and 12 / 1999, urethral reconstructions were performed in 267 consecutive patients (group I), including 68 mesh graft urethroplasties (25 %) and 30 BM urethroplasties (12 %). Between 1 / 2000 and 8 / 2004, additional 249 urethroplasties were performed: Of those, 12 % were mesh graft and 50 % BM urethroplasties (group II). Results: In patient group I, stricture recurrence was found to be the main complication of both procedures (BM 17 %, mesh 16 %). However, erectile dysfunction and curvature only occurred in the mesh graft group with 4 % and 9 %, respectively. Patient satisfaction was high in both groups (BM 96.7 %, mesh 83.3 %). Between 1 / 2000 and 8 / 2004 (group II) the number of BM urethroplasties increased to 50 %, whereas the number of mesh graft urethroplasty decreased (12 %). More than 80 % of the patients were satisfied with the results. Conclusions: Long strictures with severe spongiofibrosis represent an indication for two staged urethro­plasty (BM and mesh graft). Excellent ­results can be achieved with both techniques with a similar rate of complications. The mesh graft technique remains the last option for a complex patient group.

Key words

urethral stricture - urethroplasty - buccal mucosa - mesh graft

References

• 1 Schreiter F. Die Zweizeitige Urethraplastik.  Urologe. 1998;  37 42-50
• 2 McLaughlin M D, Thrasher J B, Celmer A et al. Buccal mucosal urethroplasty in patients who had multiple previous procedures.  Urology. 2006;  68 1156-1159
• 3 Schreiter F, Noll F. Mesh graft urethroplasty using split thickness skin graft or foreskin.  J Urol. 1989;  142 1223
• 4 Palmenteri E, Lazzeri M, Guazzoni G et al. New 2-staged buccal mucosal graft urethroplasty.  J Urol. 2002;  167 130-132
• 5 Jseph J V, Andrich D E, Leach C J et al. Urethroplasty for refractory anterior urethral stricture.  J Urol. 2002;  167 127-129
• 6 Demirbilek S, Kanmaz T, Aydin G et al. Outcomes of one-stage techniques for proximal hypospadias repair.  Urology. 2001;  58 267-270
• 7 Gahli A M, el-Malik E M, al-Malik T et al. One-stage hypospadias repair. Experience with 544 cases.  Eur Urol. 1999;  36 436-442
• 8 Johal N S, Nitkunan T, O’Malley K et al. The two-stage repair for severe primary hypospadias.  Eur Urol. 2006;  50 366-371
• 9 Yue Z J, Zuo L J, Wang J J et al. Free graft two-stage urethroplasty for ­hypospadias repair.  Chin Med Sci J. 2005;  20 119-122
• 10 Ferro F, Zaccara A, Spagnoli A et al. Skin graft for 2-stage treatment of severe hypospadias: back to the future?.  J Urol. 2002;  168 (4 Pt 2) 1730-1733
• 11 Carr L K, MacDiarmid S A, Webster G D. Treatment of complex anterior urethral stricture disease with mesh graft urethroplasty.  J Urol. 1997;  157 104-108
• 12 Kane C, Tarman G, Summerton D et al. Multi-institutional experience with buccal mucosa onlay urethroplasty for bulbar urethral reconstruction.  J Urol. 2002;  167 1314-1317
• 13 Bhargava S, Chapple C R. Buccal mucosal urethroplasty: is it the new gold standard?.  BJU International. 2004;  93 1191-1193
• 14 Wessel H, McAninch J W. Use of free grafts in urethral reconstruction.  J Urol. 1996;  155 1913-1915
• 15 Andrich D E, Mundy A R. Substitution urethroplasty with buccal mucosal-free grafts.  J Urol. 2001;  165 1131-1133