Surgical Atlas – Dorsal onlay oral mucosal graft bulbar urethroplasty

BJUI, 2012, 109, 1728-1741
Abstract: Several experimental studies and clinical experiences have contributed to the development and evolution of dorsal onlay urethroplasty in the surgical treatment of anterior urethral strictures. In 1979, Devine et al . popularised the use of free-skin graft techniques in anterior urethral reconstruction. In 1980, Monseur first described a new urethroplasty, opening the urethra along its dorsal surface and fi xing the opened urethra over the corpora cavernosa, thus regeneration of the urethral mucosa is obtained by leaving a catheter in place for a long period. In 1996, we combined the technique of Devine et al . with that of Monseur and described the fi rst dorsal onlay skin graft urethroplasty . In our technique, the graft is sutured to the corpora cavernosa and the urethra, which is opened along its dorsal surface and sutured to the lateral margins of the graft. Regeneration of urethral mucosa is facilitated by the graft that works as an epithelial roof strip, thus considerably reducing the time for urethral regeneration. According to experimental and clinical studies by Weaver and Schulte and Moore, the dorsal buried epithelial strip facilitates urethral regeneration without formation of scar tissue. Over time, our original technique has been greatly improved and new changes are continuously being suggested using fi brin glue, muscle and nerve-sparing approaches, and minimally invasive techniques. We present here, step by step, the surgical technique of dorsal onlay oral mucosal graft bulbar urethroplasty using a minimally invasive technique with a muscle and nerve-sparing approach and fibrin glue.