Abstract: PD60-07
Sources of Funding: none

Introduction

Anterior urethral stricture is a challenging disease. Multiplicity of surgical techniques denotes that none is ideal. Very few prospective randomized studies are available to compare different techniques. _x000D_ Our aim is to compare the use of buccal mucosal graft (BG) versus local penile skin flaps (PF) in patients with complex anterior urethral strictures.

Methods

A total of 34 adult patients with complex anterior urethral stricture were included. A complex anterior urethral stricture was defined as a stricture length of > 2 cm and/or previous failed procedures, including urethral dilatation, internal optical urethrotomy (OU) and urethroplasty. We randomised patients to undergo either buccal mucosa dorsal onlay graft or ventral onlay local penile skin flap urethroplasty. Successful treatment outcome was defined as no further treatment of the urethral stricture required after urethroplasty and peak flow rate > 15 ml/s. We compared operative time, estimated blood loss, complications, and recurrence rates in both groups.

Results

Mean follow up was 22.3 months in BG group vs 18.9 months in PF group. The number of penile, bulbar and bulbo-penile strictures as well as median stricture length (40 mm in BG group Vs. 50 mm in PF group) were not statistically different between the two groups._x000D_ Mean operative time was 185.9 min and 190.6 min in BG group and PF group respectively. Estimated blood loss was significantly higher in PF group, (median 400 ml and 300 ml in PF and BG group respectively, p= 0.003). _x000D_ Regarding complications, two patients (11.8%) in each group developed wound infection, one patient (5.9%) in PF group had urinary fistula, and one patient (5.9%) presented by ventral chordee post operatively. In BG group, only one patient (5.9%) developed mild limitation of mouth opening. _x000D_ The success rates in the buccal mucosal (88.2%) and penile flap (88.2%) groups were similar.

Conclusions

On intermediate follow up, dorsal onlay buccal mucosa and ventral onlay penile skin flap urethroplasty provide similar success rates. PF group had significantly higher blood loss, but no blood transfusion was required in both groups. Since no statistically significant difference in outcomes and complication rates were observed between BG and PF, both techniques are recommended for the treatment of complex anterior strictures, based on the surgeon's expertise. Further studies with longer term follow-up periods & higher sample sizes are needed to elucidate subtle differences between both techniques.

Funding

none