Dorsal oral mucosal onlay graft urethroplasty

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Mohammed Abd El Wadood

Dorsal oral mucosal onlay graft urethroplasty for more urology resources visit: uronotes2012.blogspot.com

The surgical treatment of an injury or defect within the urethra's walls is known as urethroplasty. The three most frequent factors leading to urethral damage that needs to be repaired are trauma, iatrogenic injury, and infections. The gold standard treatment for urethral strictures is urethroplasty, which has a lower recurrence rate than dilatations and urethrotomies. Although recurrence rates are higher for this challenging treatment group, it is likely the only effective treatment option for chronic and severe strictures. Urethroplasty is not regarded as a small procedure, taking three to eight hours on average in the operating room. Between 20% and 30% of urethroplasty patients may benefit from the ease of going under the knife for a shorter period of time and going home the same day. On average, hospital stays last two to three days. Seven to ten days may be needed for hospitalization for more complicated surgeries. Fewer than ten percent of patients experience significant complications after urethroplasty, while complications, particularly recurrences, are more frequent in long and complex strictures.

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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

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