Bulbar uretheral stricture repair with buccal mucosa graft urethroplasty

To evaluate the use of buccal mucosa graft in single stage urethral reconstruction of bulbar urethral stricture.

In Armed Forces Institute of Urology Rawalpindi, from Jan 2008 to Oct 2009, 56 patients underwent single stage dorsal onlay urethroplasty using buccal mucosa graft for long bulbar urethral strictures (> 2cm). Urethra was incised along the strictured segment in the 12 o'clock (dorsal) position starting from the distal end. A buccal mucosa graft of required length was harvested. The graft was anchored in a spread fixed fashion to the corporal bodies opposing the dorsally incised strictured urethra. The urethra was rotated back to the normal anatomic position. The margins of urethral incision were sutured to the fixed graft edge and corporal body using interrupted 4-0 vicryl. After completion of right margin's stitches, a 16 Fr silicon catheter was placed and then left margin stitches were completed.

Only 54 out of 56 patients could be evaluated because 2 patients were lost to follow up. Mean age of the patients was 48 +/- 11.32 years (range 19-67 yrs). Mean length of the buccal mucosa graft was 3.4 +/- 0.6 cm (range 2.6 - 5.5 cm). Duration of follow up was 4-20 months, mean 16.3 +/- 3.65 months. In 47 (87%) patients, the procedure was successful, 7 (13%) patients developed recurrence, out of these 7 patients, 2 (3.7%) required optical urethrotomy and 5 (9.25%) patients responded to urethral dilatation. Mean operative time was 92 +/- 13.22 minutes.

Buccal mucosa graft urethroplasty produces encouraging results in long bulbar urethral strictures. Longer follow up is required.