Transurethral ventral buccal mucosa graft inlay urethroplasty for reconstruction of fossa navicularis and distal urethral strictures: surgical technique and preliminary results

Abstract

Objectives:
To introduce a novel surgical technique for the reconstruction of distal urethral strictures using buccal mucosal graft (BMG) through a transurethral approach.

Methods:
A retrospective institution chart review was conducted of all the patients who underwent a transurethral ventral BMG inlay urethroplasty from March 2014 to March 2016. Patients with greater than one-year follow-up were included. Steps of the procedure: transurethral ventral wedge resection of the stenosed segment and transurethral delivery and spread fixation of appropriate BMG inlay into the resultant urethrotomy. The patients were followed for post-operative complications and stricture recurrence with uroflow, PVR, cystoscopy and outcome questionnaires.

Results:
Three patients with a minimum of 12-month follow-up are included in this case series. The mean age of the patients was 42 years (35-53); mean stricture length was 2.1 cm (1-4). All patients had at least 2 previous failed procedures. Mean follow-up was 18 months (12-24). There were no stricture recurrences or fistula. Mean pre- and post-operative uroflow values were 4.3 (0-8) and 19 (16-26), respectively. Neither penile chordee nor changes in sexual function were noted in patients on follow-up.

Conclusion:
Transurethral ventral BMG inlay urethroplasty is a feasible option for treatment of fossa navicularis strictures. This single-stage technique allows for avoiding skin incision or urethral mobilization. It helps to prevent glans dehiscence, fistula formation and avoids the use of genital skin flaps in all patients, especially those affected with LS. This novel surgical technique is an effective treatment alternative for men with distal urethral strictures.

Full text

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Int Urol Nephrol (2016) 48:1823–1829
DOI 10.1007/s11255-016-1381-1
UROLOGY - ORIGINAL PAPER
Transurethral ventral buccal mucosa graft inlay urethroplasty
for reconstruction of fossa navicularis and distal urethral
strictures: surgical technique and preliminary results
Dmitriy Nikolavsky1 · Mourad Abouelleil1 · Michael Daneshvar1
Received: 13 June 2016 / Accepted: 19 July 2016 / Published online: 28 July 2016
© Springer Science+Business Media Dordrecht 2016
skin flaps in all patients, especially those affected with LS.
This novel surgical technique is an effective treatment
alternative for men with distal urethral strictures.
Keywords Urethral stricture · Fossa navicularis ·
Meatoplasty · Lichen sclerosus · Urethroplasty · Buccal
mucosa graft
Introduction
Reconstructive urologic surgery has vastly changed in the
past three decades with the introduction of BMG for ure-
thral reconstruction [1, 2]. Subsequently, a variety of new
surgical techniques to treat urethral stricture disease have
been developed [3, 4]. Surgical repair of distal penile and
fossa navicularis strictures (FNS) however remains a chal-
lenging issue within reconstructive urology due to the
nature of the strictures, their underlying pathology and ana-
tomical considerations. Herein, we propose a novel surgical
technique that may help to avoid inherent technical difficul-
ties and surgical complications.
Most of the previously described options for the man-
agement of FNS include either a ventral or a circumfer-
ential skin incision to access the urethra for a ventral ure-
throtomy. Through these incisions a buccal mucosa graft,
a fasciocutaneous flap or a combination of both are used to
reconstruct the affected urethral lumen [5–7]. All of these
techniques require external skin incisions in an area that is
less forgiving than the perineum, therefore often leading
to less than desirable cosmetic and functional outcomes.
Additionally, some of the techniques employ the use of
local genital skin for urethral reconstruction. Since this area
is frequently affected by lichen sclerosis (LS), genital skin
use is discouraged due to a high risk of disease recurrence
Abstract
Objectives To introduce a novel surgical technique for
the reconstruction of distal urethral strictures using buccal
mucosal graft (BMG) through a transurethral approach.
Methods A retrospective institution chart review was con-
ducted of all the patients who underwent a transurethral
ventral BMG inlay urethroplasty from March 2014 to
March 2016. Patients with greater than one-year follow-
up were included. Steps of the procedure: transurethral
ventral wedge resection of the stenosed segment and tran-
surethral delivery and spread fixation of appropriate BMG
inlay into the resultant urethrotomy. The patients were
followed for post-operative complications and stricture
recurrence with uroflow, PVR, cystoscopy and outcome
questionnaires.
Results Three patients with a minimum of 12-month fol-
low-up are included in this case series. The mean age of
the patients was 42 years (35–53); mean stricture length
was 2.1 cm (1–4). All patients had at least 2 previous failed
procedures. Mean follow-up was 18 months (12–24). There
were no stricture recurrences or fistula. Mean pre- and post-
operative uroflow values were 4.3 (0–8) and 19 (16–26),
respectively. Neither penile chordee nor changes in sexual
function were noted in patients on follow-up.
Conclusion Transurethral ventral BMG inlay urethroplasty
is a feasible option for treatment of fossa navicularis stric-
tures. This single-stage technique allows for avoiding skin
incision or urethral mobilization. It helps to prevent glans
dehiscence, fistula formation and avoids the use of genital
* Dmitriy Nikolavsky
Nikolavd@upstate.edu
1 Department of Urology, SUNY Upstate Medical University,
750 East Adams Street, Syracuse, NY 13210, USA
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