Tunica albuginea versus buccal mucosa graft urethroplasty for anterior urethral stricture: A prospective randomised pilot study
Mohammad Shazib Faridia*(),Vikas Sharmab,Adittya K. Sharmac,Rahul Yadavc
aDivision of Urology, Department of Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, New Delhi, India bDepartment of Urology, Rajiv Gandhi Super Speciality Hospital, Tahirpur, Delhi, India cDepartment of Urology, Apollomedics Super Speciality Hospital, Lucknow, Uttar Pradesh, India
Objective: The objective of the study was to compare the outcome of tunica albuginea urethroplasty (TAU) and buccal mucosa graft (BMG) urethroplasty for anterior urethral stricture. Methods: Thirty patients who met the inclusion criteria were randomised into two groups: TAU (Group A) and BMG urethroplasty (Group B). Surgical outcome was evaluated with pre- and post-operative work-up involving retrograde urethrogram, voiding cystourethrogram, uroflowmetry, and urethroscopy. Patients were followed up till 1 year. Results: Mean duration of surgery was statistically significant between two groups (p=0.0005). Maximum urine flow rate was comparable when compared between two groups (p=0.22) but statistically significant when compared pre- and post-operatively (p<0.001). At follow-up of 1 year, the successful outcomes were 80% in Group A and 87% in Group B. A total of five patients who had unsuccessful results required redo urethroplasty. Complications were minimal in both the groups. Conclusion: TAU provides outcomes equivalent to those of BMG urethroplasty. TAU has less operative time, easy to perform, and beneficial in patients with poor oral hygiene.
. [J]. Asian Journal of Urology, 2023, 10(2): 189-194.
Mohammad Shazib Faridi,Vikas Sharma,Adittya K. Sharma,Rahul Yadav. Tunica albuginea versus buccal mucosa graft urethroplasty for anterior urethral stricture: A prospective randomised pilot study. Asian Journal of Urology, 2023, 10(2): 189-194.
McCammon KA, Zuckerman JM, Jordan GH. Surgery of penis and urethra. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh urology. 11th ed. Philadelphia, PA: Elsevier Saunders; 2016.p917.
[2]
Payne SR, Fowler S, Mundy AR. Analysis of a 7-year national online audit of the management of open reconstructive urethral surgery in men. BJU Int 2020; 125:304-13.
doi: 10.1111/bju.14897
pmid: 31419368
[3]
Andrich DE, Dunglison N, Greenwell TJ, Mundy AR. The longterm results of urethroplasty. J Urol 2003; 170:90-2.
doi: 10.1097/01.ju.0000069820.81726.00
pmid: 12796652
[4]
Eltahawy EA, Virasoro R, Schlossberg SM, McCammon KA, Jordan GH. Long-term follow-up for excision and primary anastomosis for anterior urethral strictures. J Urol 2007; 177:1803-6.
doi: 10.1016/j.juro.2007.01.033
pmid: 17437824
Mangera A, Patterson JM, Chapple CR. A systematic review of graft augmentation urethroplasty techniques for the treatment of anterior urethral strictures. Eur Urol 2011; 59:797-814.
doi: 10.1016/j.eururo.2011.02.010
pmid: 21353379
[8]
Chapple C, Andrich D, Atala A, Barbagli G, Cavalcanti A, Kulkarni S, et al. SIU/ICUD consultation on urethral strictures: the management of anterior urethral stricture disease using substitution urethroplasty. Urology 2014; 83:S31-47. https://doi.org/10.1016/j.urology.2013.09.012.
doi: 10.1016/j.urology.2013.09.012
[9]
Barbagli G, Lazzeri M. Surgical treatment of anterior urethral stricture diseases: brief overview. Int Braz J Urol 2007; 33: 461-9.
doi: 10.1590/s1677-55382007000400002
pmid: 17767749
[10]
Lumen N, Oosterlinck W, Hoebeke P. Urethral reconstruction using buccal mucosa or penile skin grafts: systematic review and meta-analysis. Urol Int 2012; 89:387-94.
doi: 10.1159/000341138
pmid: 22889835
[11]
Markiewicz M, Lukose MA, Margarone JE 3rd, Barbagli G, Miller KS, Chuang SK. The oral mucosa graft: a systematic review. J Urol 2007; 178:387-94.
doi: 10.1016/j.juro.2007.03.094
pmid: 17561150
[12]
Dublin N, Stewart LH. Oral complications after buccal mucosal graft harvest for urethroplasty. BJU Int 2004; 94:867-9.
doi: 10.1111/j.1464-410X.2004.05048.x
pmid: 15476524
[13]
Jang TL, Erickson B, Medendorp A, Gonzalez CM. Comparison of donor site intraoral morbidity after mucosal graft harvesting for urethral reconstruction. Urology 2005; 66:716-20.
doi: 10.1016/j.urology.2005.04.045
pmid: 16230123
Barbaglia G, Balòa S, Sansaloneb S, Lazzeric M. How to harvest buccal mucosa from the cheek. Afr J Urol 2016; 22:18-23.
doi: 10.1016/j.afju.2015.09.001
Sharma AK, Ratkal CS, Shivlingaiah M, Girish GN, Sanjay RP, Venkatesh GK. Analysis of short-term results of Monsieur’s tunica albuginea urethroplasty as a definitive procedure for pan-anterior urethral stricture. Urol Ann 2013; 5:228-31.
doi: 10.4103/0974-7796.120291
[18]
Mathur RK, Aggarwal H, Odiya S. Technique of anterior urethra urethroplasty using tunica albuginea of corpora cavernosa. Int J Urol 2007; 14:209-13.
doi: 10.1111/j.1442-2042.2007.01683.x
pmid: 17430257
[19]
Mathur RK, Aggarwal H, Odiya S. A technique of anterior urethroplasty using the tunica albuginea of the corpora cavernosa. Asian J Surg 2008; 31:134-9.
doi: 10.1016/s1015-9584(08)60074-3
pmid: 18658012
[20]
Monseur J. [A new procedure for urethroplasty for urethral stricture: reconstruction of the urethral canal by means of suburethral strips and the subcavernous groove]. J Urol Nephrol 1969; 75:201-9.[Article in French].
[21]
Barbagli G, De Stefani S, Annino F, De Carne C, Bianchi G. Muscle- and nerve-sparing bulbar urethroplasty: a new technique. Eur Urol 2008; 54:335-43.
doi: 10.1016/j.eururo.2008.03.018
pmid: 18384930
[22]
Kulkarni S, Barbagli G, Sansalone S, Lazzeri M. One-sided anterior urethroplasty: a new dorsal onlay graft technique. BJU Int 2009; 104:1150-5.
doi: 10.1111/j.1464-410X.2009.08590.x
pmid: 19388990
[23]
Spilotros M, Sihra N, Malde S, Pakzad MH, Hamid R, Ockrim JL, et al. Buccal mucosal graft urethroplasty in men-risk factors for recurrence and complications: a third referral centre experience in anterior urethroplasty using buccal mucosal graft. Transl Androl Urol 2017; 6:510-6.
doi: 10.21037/tau.2017.03.69
pmid: 28725593
[24]
Barbagli G, Morgia G, Lazzeri M. Retrospective outcome analysis of one-stage penile urethroplasty using a flap or graft in a homogeneous series of patients. BJU Int 2008; 102:853-60.
doi: 10.1111/j.1464-410X.2008.07741.x
pmid: 18485036
[25]
Snodgrass W, Bush N. Tubularized incised plate proximal hypospadias repair: continued evolution and extended applications. J Pediatr Urol 2011; 7:2-9.
doi: 10.1016/j.jpurol.2010.05.011
pmid: 20598641
[26]
Chu YC, Wang TM, Wang HH, Chu SH, Chen HW, Chiang YJ, et al. Outcomes of urethroplasty for anterior urethral strictures: a single-center experience. Urol Sci 2020; 31:46-50.
doi: 10.4103/UROS.UROS_54_19
[27]
Datta B, Rao MP, Acharya RL, Goel N, Saxena V, Trivedi S, et al. Dorsal onlay buccal mucosal graft urethroplasty in long anterior urethral stricture. Int Braz J Urol 2007; 33:181-7.
pmid: 17488537
[28]
Prabha V, Devaraju S, Vernekar R, Hiremath M. Single stage: dorsolateral onlay buccal mucosal urethroplasty for long anterior urethral strictures using perineal route. Int Braz J Urol 2016; 42:564-70.
doi: 10.1590/S1677-5538.IBJU.2015.0184
pmid: 27286122
[29]
Sinha RJ, Singh V, Sankhwar SN, Dalela D. Donor site morbidity in oral mucosa graft urethroplasty: implications of tobacco consumption. BMC Urol 2009; 9:15. https://doi.org/10.1186/1471-2490-9-15.
doi: 10.1186/1471-2490-9-15
pmid: 19772567
[30]
Dogra PN, Saini AK, Seth A. Erectile dysfunction after anterior urethroplasty: a prospective analysis of incidence and prob-ability of recoverydsingle-center experience. Urology 2011; 78:78-81.
doi: 10.1016/j.urology.2011.01.019
pmid: 21550645
[31]
Blaschko SD, Sanford MT, Cinman NM, McAninch JW, Breyer BN. De novo erectile dysfunction after anterior urethroplasty: a systematic review and meta-analysis. BJU Int 2013; 112:655-63.
doi: 10.1111/j.1464-410X.2012.11741.x
pmid: 23924424