Ventral onlay oral mucosal graft bulbar urethroplasty

BJU Int 2011; 108: 1218-1231.
The current surgical approach to the uncomplicated bulbar urethral stricture began in 1993 when El-Kasaby et al . described the repair of anterior urethral strictures using an oral mucosa graft, including eight patients who underwent bulbar urethroplasty. In 1996, Morey and McAninch first described ventral onlay oral mucosa urethroplasty, suggesting suturing of the oral graft in the ventral surface of the urethra. In 1996, Barbagli et al . described the dorsal free-graft urethroplasty, suggesting suturing the graft in the dorsal surface of the urethra, over the albuginea of the underlying corpora cavernosa. The location of the graft on the ventral or dorsal urethral surface has become a contentious issue, dating from the time these two techniques were described. Success with bulbar oral mucosal grafts has been high with dorsal or ventral graft location and the different graft positions have shown no differences in success rates. Recently, we developed a new muscle and nerve-sparing bulbar urethroplasty, avoiding fully opening the bulbo-spongiosum muscle, thus better preserving ejaculatory function. The selection of a surgical technique for bulbar urethra reconstruction, in addition to respecting the status of the genitalia tissue and components, must also be based on the proper anatomical characteristics of the bulbar urethra, to ensure graft take and survival. Further, sexual function can be placed at risk by any surgery on the genitalia, and dissection must avoid interference with the neurovascular supply to the penis and genitalia. Bulbar urethroplasty using grafts should not compromise penile length or cause penile chordee, and certainly should not untowardly affect penile and genitalia appearance.