Long segment urethral strictures with a very narrow lumen pose an immense challenges for buccal mucosa augmentation urethroplasty.
Larger discrepancy in size of the graft and the native urethral plate makes it difficult to place the sutures and also makes the graft vulnerable to contracture and fibrosis.
Increasing the width of the urethral plate by a vertical midline mucosal incision and applying an additional inlay buccal mucosal graft may lessen the discrepancy and help in improving the adequacy of the urethral lumen.
Other option to deal with these kind of strictures is dorsal onlay and ventral inlay.
Spongiofibrosis is never full thickness except in traumatic injury ( straddle injury/blunt trauma)
Partial thickness Spongiofibrosis and scarred mucosa can be removed completely and replaced by buccal mucosa.
Lithotomy position
Epidural + general anesthesia.
Vertical perineal incision. Mobilization of bulbar urethra
Dorsal ( one side kulkarni’s technique)or ventral urethrotomy
Vertical midline incision or complete removal of scarred urethral plate with removal of thin layer of spongiofibrosis.
Inlay and onlay grafting done
Urethra closed over 16 fr
Results were analysed on the basis of pre and post operative uroflowmetry.
Any kind of instrumentation was considered as failure.
Mean follow up 630 days.
22 patients have significant better flow rate after surgery
One patient developed ring stricture near proximal anastomosis and managed by urethral dilatation.
One patient developed abscess followed by urine leak and was managed conservatively with indwelling catheter and antibiotics.
Combined urethroplasty avoid complete transection of urethra.
It widens the native urethral plate in an anatomical manner
Reduces the disparity between urethral plate and onlay buccal mucosa.
improves the success rate of long and very narrow bulbar urethra strictures
1. COMBINED INLAY AND ONLAY BUCCAL
MUCOSA URETHROPLASTY FOR LONG
AND NARROW BULBAR URETHRAL
STRICTURES
DR. GAUTAM BANGA
RECONSTRUCTIVE UROLOGIST
CENTRE FOR URETHRA AND PENILE SURGERY (UPS)
NEW DELHI, INDIA
2. SHORT SEGMENT STRICTURE -6 FR URETROSCOPE
CAN BE NEGOTIATED –SINGLE SIDE BUCCAL
MUCOSA IS SUFFICIENT.
3. BUT WHAT TO DO ABOUT STRICTURE WHICH DOES
NOT EVEN HAVE A CALIBRE OF 6FR
4. INTRODUCTION:
Long segment urethral strictures with a very narrow
lumen pose an immense challenges for buccal
mucosa augmentation urethroplasty.
Larger discrepancy in size of the graft and the
native urethral plate makes it difficult to place the
sutures and also makes the graft vulnerable to
contracture and fibrosis.
Increasing the width of the urethral plate by a
vertical midline mucosal incision and applying an
additional inlay buccal mucosal graft may lessen
the discrepancy and help in improving the
adequacy of the urethral lumen.
5. INTRODUCTION
Other option to deal with these kind of strictures is
dorsal onlay and ventral inlay.
Spongiofibrosis is never full thickness except in
traumatic injury ( straddle injury/blunt trauma)
Partial thickness Spongiofibrosis and scarred
mucosa can be removed completely and replaced
by buccal mucosa.
6. SURGICAL TECHNIQUE:
Lithotomy position
Epidural + general anesthesia.
Vertical perineal incision. Mobilization of bulbar
urethra
Dorsal ( one side kulkarni’s technique)or ventral
urethrotomy
Vertical midline incision or complete removal of
scarred urethral plate with removal of thin layer of
spongiofibrosis.
Inlay and onlay grafting done
Urethra closed over 16 fr
11. RESULTS:
Results were analysed on the basis of pre and post
operative uroflowmetry.
Any kind of instrumentation was considered as
failure.
Mean follow up 630 days.
22 patients have significant better flow rate after
surgery
One patient developed ring stricture near proximal
anastomosis and managed by urethral dilatation.
One patient developed abscess followed by urine
leak and was managed conservatively with
indwelling catheter and antibiotics.
12. CONCLUSION
Combined urethroplasty avoid complete transection
of urethra.
It widens the native urethral plate in an anatomical
manner
Reduces the disparity between urethral plate and
onlay buccal mucosa.
improves the success rate of long and very narrow
bulbar urethra strictures][
