Abstract: PD60-05
Sources of Funding: none

Introduction

Buccal Mucosa Augmentation Urethroplasty has proved to be a standard of care for treatment of non-traumatic urethral strictures. However, appropriate augmentation requires a substantially wide native urethral plate in order to prevent graft- plate discrepancy, which is vital for long term success. Long urethral strictures with a very narrow urethral usually require a staged treatment due to a possible fear of failure due to graft-plate mismatch. We studied the long term results of Double faced buccal mucosa urethroplasty for long and narrow strictures.

Methods

86 patients between the age group of 24 to 72 years (Mean age 53.45 years) were subjected to double faced buccal mucosa urethroplasty from the year 2011 to 2015. 27 out of 86 (31.39%) patients had a pan-urethral stricture due to Lichen Sclerosus (LS). 38 out of 86 (44.18) patients had a post-TURP proximal bulbar stricture. 7 patients (8.13%) had a recurrent bulbar stricture after a previous BMG urethroplasty. 5 patients had a long penile urethral stricture and 9 patients had a long bulbar stricture due to LS. The mean stricture length was 7.45cm. Urethral plates less than 3mm wide were selected for double faced BMG. In pan-urethral and penile strictures dorsal onlay and ventral inlay grafts were applied. In the bulbar strictures dorsal inlay and ventral onlay grafts were applied. 16Fr Foley was placed in all patients for 3 weeks. _x000D_ Inlay grafting was done by incising the urethral plate deep enough to expose a healthy spongiosal tissue.

Results

The longest follow-up was about 54 months and the mean follow-up duration was 37.65 months. All patients had a maximum flow rate > 18ml/Sec (Mean 15.62ml/Sec). 4 patients with LS had meatal restenosis which was treated by ventral meatotomy. 2 patients with bulbar stricture had urethro-cutaneous fistulae from the incision site which closed spontaneously with prolonged catheterization. 8 patients with ventral onlay BMG complained of post void dribbling which was corrected with an advise of perineal compression after urination. Inlay BMG widened the diseased urethral plate from an average of 2mm to 7.5mm. This prevented the discrepancy between the onlay graft and the urethral plate. _x000D_

Conclusions

Application of an inlay BMG widens the narrow urethral plate and prevents significant graft-plate mismatch. Widening of the urethral plate offers tension free urethral closure and better long term results. Double faced BMG urethroplasty offers better results in long and narrrow strictures by preventing graft-plate discrepancy.

Funding

none