A novel composite two-stage urethroplasty for complex penile strictures: A multicenter experience

Area of Science:

• Urology
• Reconstructive Surgery
• Andrology

Background:

• Complex penile strictures often require two-stage urethroplasty.
• Buccal mucosal graft (BMG) in the first stage can lead to significant contraction and revision surgery.
• A composite two-stage technique using BMG for salvageable urethral plates is explored.

Purpose of the Study:

• To evaluate the stricture-free success rate of a composite two-stage penile urethroplasty using BMG.
• To assess the efficacy of this technique in complex penile stricture repair.
• To determine if this method reduces BMG contraction rates.

Main Methods:

• A multi-institutional cohort of 82 patients with complex penile strictures underwent two-stage urethroplasty.
• 42 patients receiving the composite two-stage urethroplasty with BMG at the second stage were included.
• Exclusion criteria included genital lichen sclerosus and incomplete records; primary outcome was stricture-free success.

Main Results:

• 38 patients were available for analysis after 4 lost to follow-up.
• The mean stricture length was 4.5 cm, with 44.7% having prior urethroplasty.
• At a median 44-month follow-up, 89.5% (34/38) achieved success, with 10.5% recurrence.

Conclusions:

• The composite two-stage urethroplasty using BMG is a valid and reproducible surgical option for complex penile strictures.
• This technique may decrease the contraction rate of the transplanted buccal mucosal graft.
• No patients required revision before the second stage or redo buccal graft harvesting.