History and evolution of dorsal onlay urethroplasty for bulbar urethral stricture repair using skin or buccal mucosal grafts

Urologia 2007; 74: 233-241.

Objectives: To illustrate the history and the evolution over time of bulbar dorsal onlay urethroplasty, comparing the outcome between the use of buccal mucosa and skin grafts.

Materials and Methods: Ninety-four patients underwent bulbar urethral reconstruction using two dorsal onlay techniques, namely augmented anastomotic urethroplasty and dorsal onlay graft urethroplasty. Preoperative evaluation included clinical history, physical examination, urine culture, residual urine measurement, uroflowmetry and urethrography. Thirty-four patients underwent augmented anastomotic urethroplasty using penile skin (10 cases) or buccal mucosa (24 cases) grafts. Sixty patients underwent dorsal onlay graft urethroplasty using penile skin (38 cases) or buccal mucosa (22 cases) grafts. Out of 94 patients, 48 received skin grafts and 46 buccal mucosal grafts.

Results: Out of 94 cases, 64 (68%) were successful and 30 (32%) failures. The 34 augmented anastomotic urethroplasties provided success in 24 cases (70.6%) and failure in 10 (29.4%). The 60 dorsal onlay graft urethroplasty provided success in 42 cases (70%) and failure in 18 (30%). Out of 48 penile skin grafts, 28 (58.3%) were successful and 20 (41.7%) failures. Out of 46 buccal mucosa grafts, 36 (78.3%) were successful and 10 (21.7%) failures. The 30 failures were treated with internal urethrotomy in 14 cases (46.7%), perineal urethrostomy in 8 cases (26.7%), two-stage repair in 4 cases (13.3%), and one-stage repair in 4 cases (13.3%).

Conclusions: The dorsal onlay technique used for repair bulbar urethral strictures was changed over time. In our experience, the buccal mucosa seems to be the best substitute graft material for bulbar urethroplasty using dorsal approach.