Ces Urol 2022, 26(3):193-201 | DOI: 10.48095/cccu2022023

Buccal mucosal graft substitution urethroplasty of posterior penile and bulbar urethra

Tomáš Ürge, Olga Dolejšová, Jiří Kouba, Milan Hora

Urologická klinika FN Plzeň

Ürge T, Dolejšová O, Kouba J, Hora M. Buccal mucosal graft substitution urethroplasty of posterior penile and bulbar urethra.

Introduction: We started using buccal mucosal graft in November 2019 to treat recurrent strictures of the urethra outside the anastomosis area in patients after laparoscopic radical prostatectomy (LRP) and subsequently also performed it for strictures from other causes. Group: The group includes 14 men aged 66.7 ± 6.8 years who had recurrent stricture of the posterior penile to bulbar Jordan D urethra 18-73 mm (diameter 25 mm) according to urethrography. The cause of the stricture was instrumentation in the urethra in 11/14 (78%) patients. In one patient, the cause was an allergic reaction to the catheter material, another was after chlamydial urethritis, and the last one had a traumatic stricture after a fall and blunt trauma to the perineum more than 10 years ago.

Material and methods: The intraoperative length of the stricture (necessary length of the graft) was approximately 25-140 mm, an average of 50 mm. The procedure was 163 ± 29 minutes long. Patients were discharged on the 3^rd-5^th postoperative day. Postoperative complications were noted in only one patient. It was a fistula in the penoscrotal angle, which healed after the establishment of an epicystostomy and the subsequent stricture of the urethra at the site of the Jordan B fistula, which was solved by an endoscopic incision followed by regular selfdilatation.

Results: Patients were monitored 5-28 months after the procedure, urine without residues, Q_max on UFM is on average 14 ± 4 ml/s (Qaverage 10 ± 3 ml/s). All patients evaluated the procedure positively, no one suffered for urinary infection or urinary retention. Four patients (previously after LRP) have grade I-II stress incontinence.

Conclusion: In conclusion, urethroplasty using a graft from the buccal mucosa is an option to treat urethral stricture in patients with severe spongiofibrosis. The published results are encouraging, but we are aware of the limits of the work, due to the short follow-up period.

Keywords: Urethral stricture, mouth mucosa, reconstructive surgical procedures.

Received: May 2, 2022; Revised: August 9, 2022; Accepted: August 21, 2022; Prepublished online: August 21, 2022; Published: September 21, 2022