Circumferential substitution oral mucosal onlay graft urethroplasty

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The surgical technique of “Urethroplasty with skin or oral mucosal graft” is made by opening the urethra at the level of the stricture site and widening the urethral lumen by applying an oral graft.

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There are four basic types of Urethroplasty with skin or oral mucosal graft:

  • Urethroplasty with ventral oral mucosal graft. Using this technique, the oral graft is sutured on the ventral site of the urethra (figures 1,2).
  • Urethroplasty with dorsal skin or oral mucosal graft. Using this technique, the oral graft is sutured on the dorsal site of the urethra (figures 3,4).
  • Urethroplasty with lateral oral mucosal graft. Using this technique, the oral graft is sutured on the lateral site of the urethra.
  • Urethroplasty with complete substitution by oral mucosal graft. Using this technique, the urethral mucosa is completely replaced by an oral graft.

 

The surgical technique of Urethroplasty with skin or oral mucosal graft is generally suggested in the patients with no traumatic bulbar urethral strictures, more than 2 cm in length.

Articolo n° 1
Barbagli G, Palminteri E, Lazzeri M, Guazzoni G.
One-stage circumferential buccal mucosa graft urethroplasty for bulbous stricture repair
Urology. 2003 Feb;61(2):452-5.

A one-stage onlay urethroplasty, using a buccal mucosa graft, is presented for patients with bulbous strictures in whom the urethral mucosa is seriously involved in the disease. Of 40 patients who underwent a dorsal buccal mucosa graft urethroplasty for bulbous urethral strictures, 5 required complete removal of the urethral mucosa and its replacement by a buccal mucosa graft. All these patients had undergone previous urethrotomy with a false passage inside the bulbous urethra and had a suprapubic tube in place. The goal of removal and replacement of the urethral mucosa in each case was to create a new, wide urethral mucosal bed to promote successful one-stage reconstruction. All patients voided spontaneously without problems after removal of the catheter. After 4 months, the mean peak flow was 21 mL/s. After 6 months, urethroscopy did not show any stricture recurrence. None of the patients required instrumentation or dilation. In patients with bulbous urethral strictures and false passage into the mucosa and spongiosum tissues, the complete removal and replacement of the urethral mucosa using a circumferential buccal mucosa graft promotes successful one-stage urethral reconstruction.
Articolo n° 2
Barbagli G., Guazzoni G., Lazzeri M.
One-Stage bulbar urethroplasty: Retrospective analisys of the results in 375 patients
Eur Urol 2008; 53:828-33

Objective: To review the outcome of bulbar urethroplasty using one-stage surgical techniques.
Methods: Of 375 patients, who underwent one-stage bulbar urethroplasties, 165 patients (44%) underwent anastomotic repair (AR), 40 (10.7%) underwent augmented anastomotic repair (AAR) using penile skin grafts (PSGs) or oral mucosal grafts (OMGs), and 170 (45.3%) underwent onlay grafting techniques (OGTs) using PSGs or OMGs. Clinical outcome was considered a failure when any postoperative instrumentation was needed. The chi(2) and Fisher’s exact test for categorical data were used. The sample size of 375 patients provides a statistical power (1-beta) of 99% at alpha=0.05; p<0.05 was set as significant.
Results: The average follow-up was 53 mo. Of 375 cases, 313 (83.5%) were successful and 62 (16.5%) failures. Of 165 ARs, 150 (90.9%) were successful and 15 (9.1%) failures. Of 40 AARs, 24 (60%) were successful and 16 (40%) failures. Of 170 OGTs, 139 (81.8%) were successful and 31 (18.2%) failures. The AR showed statistically significant higher success rate compared to OGT (p=0.023) and AAR (p=0.0001). Of 47 PSGs, 28 (59.6%) were successful and 19 (40.4%) failures. Of 163 OMGs, 135 (82.8%) were successful and 28 (17.2%) failures. This difference was statistically significant (p=0.002).
Conclusions: One-stage bulbar urethroplasties showed an overall 83.5% success rate. The AR showed the higher success rate compared to the OGT or AAR. OMGs (82.8% success rate) perform statistically better than PSGs (59.6% success rate).
1. Question: Can the surgical procedure be performed with full coverage by the National Health Care System?
Answer: Yes.

2. Question: What kind of anesthesia is used for this surgery?
Answer: General anesthesia with nasal intubation.

3. Question: How many hours does the surgery take?
Answer: About 2 hours.

4. Question: Are there any risks concerning erection, fertility and urinary incontinence after the surgery?
Answer: No, there aren’t.

5. Question: How many days of hospital recovery are expected following the surgery?
Answer: In general, from 5 to 7 days.

6. Question: How long will I have to use a catheter after the surgery?
Answer: The urethral catheter must stay in place for four weeks after the surgery, when the first post-operative voiding urethrography is done.

7. Question: Are there any particular recommendations during convalescence?
Answer: During convalescence, the use antibiotics until the catheter is removed is suggested. Avoiding long car trips, as well as heavy labor and sexual and sports activities are also suggested.

8. Question:: When will I be able to resume my working, sexual and sports activities?
Answer: All these activities can be gradually resumed about 30 days after the removal of the catheter.

9. Question: Can I ride a bike or a motorcycle immediately after the surgery?
Answer: It is not recommended to ride bikes, motorcycles or horses after the surgery.

10. Question:: What kinds of foods and drinks should be avoided after the surgery?
Answer: Beer and sparkling wines should be avoided, as well as large quantities of chocolate, cocoa, nuts and shellfish.