1) The document discusses the reliability, simplicity, and outcomes of dorsal versus ventral grafting techniques for urethral stricture repair. 2) It notes that the dorsal approach may offer a wider graft placement and better conditions for graft survival. However, no single technique is best for all cases. 3) Outcomes data showed the dorsal grafting technique had a higher success rate, but more experience is still needed to conclude if dorsal or ventral positioning is clearly superior. Patient factors like stricture characteristics and comorbidities are also important to consider.

1. Dorsal or Ventral??

2. • Reliability
• Simplicity and Easiness
• Outcomes

5. Reliability

7. • graft being splayed
Barbagli stated that dorsal grafting by the
dorsal urethrotomy approach offers a
wider augmentation than ventral or
dorsal grafting using the ventral-
urethrotomy approach.

9. Why not ventral Approach?
• more bleeding a risk of vascular damage when
cutting ventrally,
• the risk of graft weakening with urethral
sacculation or fistula.
• postvoid dribbling that we find in 20% of our
patients.
• the spongiosum is thinner in the distal bulbar
urethra it might be advisable not to use this
approach in this -segment.

12. • This provided an elliptical raw area of up
to 1.5–2 cm between the incised dorsal
edges of the urethra over the tunica
albuginea.

13. No single technique is appropriate for all situations, and this
statement is true for this technique.
In patients with a narrow urethral plate, the midline incision
of the mucosal plate is difficult and the urethral mucosa is
damaged by this approach.
in these patients, the dorsal onlay graft technique provides
a better chance of success because the narrow urethral
plate is adequately augmented by a wide graft applied on
the corpora cavernosa.
The ventral inlay technique provides 1.5-cm widening of the
original urethral plate, and the dorsal onlay technique
provides 2.5-cm widening of the original urethral plate.
The technique (ventral inlay vs dorsal
onlay) should be selected according
to the stricture etiology and width of
the original urethral plate
and should not be based on the
surgeon’s preference, as the authors
suggested in this article.

14. What about surgically challenging
bulbar urethral stricture??
• Long anterior strictures
• Very Narrow urethral lumen

16. dorsal approach offers the best conditions
graft survival since the buccal mucosa
is stretched and fixed to the cavernous
bodies

18. descriptive observational retrospective study of 214 patients who underwent urethroplasty
for bulbar urethral strictures between May 1999 and November 2010 in a single high-
volume center.

19. • Following ventral opening, if the bulbar
urethral plate is found to be narrow, this could
pose a problem, especially with regard to
suturing an oral graft to such a narrow plate.

20. Simplicity

21. Does it mater that it easy to learn?

22. • Multivariable Cox regression analysis was used
to evaluate the association between surgeon
experience and treatment failure.
• Overall, 546 patients (85%) were treated with
one-stage oralmucosa urethroplasty

23. • At multivariable analysis, surgeon
experience was significantly associated
with a lower probability of treatment
failure (hazard ratio per 20 procedures:
0.98; 95% CI, 0.97–0.99; p = 0.008)

24. Any way…………..

27. Outcomes

28. PROBLEMS WITH VENTRAL APPROCH
• increased blood loss
• Increased incidence of diverticula formation
• Increased failure rate
Miroslav L. Djordjevic graft surgery in extensive anterior urethral stricture Curr Urol Rep
(2014) 15:424 Page 3 of 6, 424

29. Conclusions The dorsal stricturotomy
and patch (Barbagli) procedure had a
higher success rate than the
traditional ventral urethroplasty

32. From our experience, we cannot conclude that dorsal
or ventral graft position is inherently superior.

33. Patients with diabetes may be more likely to
require additional procedures following bulbar
urethroplasty with buccal grafting.