|Year : 2006 | Volume
| Issue : 2 | Page : 165-166
Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: Are results affected by the surgical technique?
Rajiv Goyal, Deepak Dubey, Aneesh Srivastav
Departments of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Departments of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Goyal R, Dubey D, Srivastav A. Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: Are results affected by the surgical technique?. Indian J Urol 2006;22:165-6
|How to cite this URL:|
Goyal R, Dubey D, Srivastav A. Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: Are results affected by the surgical technique?. Indian J Urol [serial online] 2006 [cited 2019 Jul 16];22:165-6. Available from: http://www.indianjurol.com/text.asp?2006/22/2/165/26585
Guido B, Enzo P, Giorgio G, Francesco M, Damiano T and Massimo L. J Urol 174, 2005; 955-8.
| Summary|| |
Buccal mucosa graft onlay presents one of the most widespread methods for the repair of strictures in the bulbar urethra, because of its thick and highly vascular spongiosum tissue. The graft may be placed on the ventral or dorsal urethral surface, according to the surgeon's experience and preference. The authors investigated the effect of the surgical technique on the outcome of 3 types of bulbar urethroplasty, using buccal mucosa. They included 50 patients who were treated for bulbar urethral strictures by use of buccal mucosa, over a period of 6 years. The graft was placed on the ventral, dorsal and lateral surface in 17, 27 and 6 cases, respectively. The outcome was considered a success or failure at the time that any post-operative procedure was needed, including dilatation. 42 (84%) were successful and 8 (16%) failed. The success rate of ventral onlay, dorsal onlay and laterally placed grafts was 84, 85 and 83%, respectively. Failures were treated with urethrotomy in 5 cases and 2-stage urethroplasty in 3 cases. The authors conclude that the site of placement of the buccal graft did not affect the outcome.
| Comments|| |
In this retrospective analysis, the authors have evaluated the effect of site of buccal mucosa graft placement on the outcome of the surgical technique. Almost similar success rates have been reported with each of these techniques. Placing a graft dorsally on the urethra is simpler and safer in the distal part of the bulbar urethra, whereas the ventral placement of the graft is more efficacious in the proximal part of the bulbar urethra, where the spongiosum tissue is thicker and better vascularized. In patients who have long urethral strictures located in the entire bulb, the lateral opening of the urethral surface can avoid the pitfalls of ventral and dorsal urethrotomy. Graft failure in distal anastomosis where the spongiosum is less vascular, may represent poor inosculation due to poor graft bed vascularity, whereas failure at the proximal anastomotic site is contributed to the under- staging of the disease during treatment. Urethrocele with post void dribbling and semen sequestration, are more common in patients with ventral onlay mucosa placement.
Although the authors have critically evaluated the outcome of different approaches to bulbar urethral stricture reconstruction with buccal mucosa, a selection bias was introduced, based on the location of the stricture. A randomized prospective trial is needed to confirm these observations.
| References|| |
|1.||Elliot SP, Metro MJ, Mc Aninch JW. Long term follow up of the ventrally placed buccal mucosa onlay graft in bulbar urethral reconstruction. J Urol 2003;169:1754-8. |
|2.||Dubey D, Kumar A, Bansal P, Srivastava A, Kapoor R, Mandhani A. substitution urethroplasty for anterior urethral strictures: a critical appraisal of various techniques. BJU Int 2003;91:215-8. |