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| Female anterior wall onlay urethroplasty with lower lip buccal mucosal graft: Importance of the laterally extended incision |
Maryam Emamia,Pejman Shadpourb,Koosha Kamalic,Nima Narimani c,*( ),Jalil Hosseinid
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a Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
b Hasheminejad Kidney Center (HKC), Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran
c Hasheminejad Kidney Center (HKC), Iran University of Medical Sciences, Tehran, Iran
d Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran |
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Abstract Objective: To describe the outcome of female anterior wall (pubic side) onlay urethroplasty with buccal mucosal graft using laterally extended surgical dissection in patients with previously failed minimally invasive techniques. Methods: From January 2016 to April 2018, 17 symptomatic patients with previously failed minimally invasive procedures were enrolled in the study. The diagnosis of urethral stricture was confirmed based on a combination of patients’ symptoms, post-void residual urine, video-urodynamics, and cystoscopy. Urethroplasty with lower lip mucosal graft was performed using the modified laterally extended dissection. Patients were evaluated pre-operatively and 12-month post-operatively with the American Urological Association symptom score, post-void residual urine, and maximum flow rate. Results: Despite the previously failed minimally invasive procedures, urethroplasty with lower lip buccal graft and laterally extended dissection resulted in favorable outcomes (success rate=94%). The mean±standard deviation of American urological association symptom score improved from pre-operative levels at the 12-month post-operative follow-up (25.82±3.97 to 10.88±5.57); so did postvoid residual urine (71.12±74.98 mL to 15.00±28.30 mL), and maximum flow rate (7.88±1.72 mL/s to 25.82±5.59 mL/s) with all statistically significant (p<0.05). Conclusion: The current study showed that female urethroplasty with buccal graft could be highly successful in experienced hands. An anterior approach could be superior to the posterior one due to higher mechanical support and lower sacculation rate. A laterally extended incision may improve visualization and better graft placement by providing wider working space. The results should be evaluated in the future studies with larger sample size.
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Received: 03 November 2020
Available online: 20 January 2023
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Corresponding Authors:
Nima Narimani
E-mail: nima_dr2001@yahoo.com
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Surgical technique. (A) Initial appearance; (B) Circumferential mucosal incision around the meatus with ample lateral extension at 3 and 9 o'clock positions; (C) Suprameatal dissection, extruding the upper aspect of the urethra; (D) Twelve o'clock incision of the urethra extending into the normal proximal mucosa (near the bladder neck); (E) Buccal mucosal grafting; (F and G) Securing graft to the urethral edges with Vicryl suture; (H) Final view while anchoring the urethra to surrounding tissue.
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| Status | AUA symptom score | Qmax, mL/s | PVR, mL | | Pre-operative | 25.82±3.97 (18-34) | 7.88±1.72 (5-10) | 71.12±74.98 (0-250) | | Post-operative | 10.88±5.57 (4-25) | 25.82±5.59 (17-37) | 15.00±28.30 (0-100) | | p-Value | <0.001a | <0.001a | 0.001b |
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Pre- and post-operative AUA symptom score, Qmax, and PVR (mean±SD [range]).
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| Study | Case, n | Follow-up, mean (range), month | Success rate, % | Method | | Hampson et al. [18] | 39 | 33 (7-107) | 77.0 | Dorsal buccal graft | | Powell and Daniels [24] | 6 | 18 | 67.0 | Dorsal buccal graft | | Mukhtar et al. [29] | 22 | 22 (5-61) | 95.5 | Ventral buccal graft | | Kowalik et al. [25] | 4 | 34 (10-75) | 100.0 | Dorsal buccal graft | | Goel et al. [23] | 8 | 15 | 62.5 | Dorsal buccal graft | | Blaivas et al. [15] | 3 | 18 (15-48) | 100.0 | Dorsal buccal graft | | Onol et al. [30] | 6 | 17 | 83.0 | Dorsal, ventral, and modified buccal graft | | Castillo et al. [31] | 2 | 18 | 100.0 | Dorsal buccal graft | | Sharma et al. [26] | 15 | 12 | 93.3 | Dorsal lingual mucosal graft | | Migliari et al. [32] | 3 | 6 | 100.0 | Dorsal buccal graft | | Present study | 17 | 12 | 94.0 | Lower lip buccal graft |
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Female urethroplasty with buccal graft series.
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