A prospective study on outcome of dorsal versus ventral buccal mucosal graft urethroplasty for bulbar urethral stricture

Jamal Shaik; Atul Gupta; M. Lakshmi Ramesh; P. Vedamurthy Reddy; Y. Yuvaraju; G. Yaswanth

doi:10.18203/2320-6012.ijrms20253142

Authors

Jamal Shaik Department of Urology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
Atul Gupta Department of Urology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
M. Lakshmi Ramesh Department of Urology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
P. Vedamurthy Reddy Department of Urology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
Y. Yuvaraju Department of Urology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
G. Yaswanth Department of Urology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20253142

Keywords:

BMG urethroplasty, IPSS, Stricture urethra

Abstract

Background: In urological practice, urethral stricture disease is a prevalent condition. In comparison to the other sites, the bulbar urethral stricture imposes a greater load. The buccal mucosal graft (BMG) has been considered an optimal kind of urethral replacement since 1941. A lifetime success rate of 92% is achieved with standard bulbar urethroplasty employing BMG. There exist several methodologies for BMG urethroplasty, namely dorsal, ventral, and lateral approaches, which depend on the discretion of the surgeon.

Methods: An observational study was done among 40 patients, divided into two groups each based on the procedure done. Age more than 18 years who are fit for the procedure, stricture length more than 2 cm on retrograde urethrogram (RGU) and patients who were willing to give informed consent were included in the study. Post operatively, all the patients were assessed at every 3-month interval up-to 18 months. The outcome parameters noticed were post voidal residual (PVR), Q_max, international prostate symptom score (IPSS) score.

Results: There was no difference between the pre-operative and post-operative Q_max, PVR, IPSS score between the study groups.

Conclusions: The findings of the present study concluded that there is no difference between dorsal and ventral onlay BMG urethroplasty in terms of increase in Q_max and decrease in PVR at the end of study period.

Metrics

Metrics Loading ...

References

Campbell Walsh Wein. Urology 12th Edition. St. Louis: Elsevier. 2020;1835

Alwaal A. Epidemiology of urethral strictures. Transl Androl Urol. 2014;3(2):209.

Palminteri E, Elisa B, Paolo V, De Nunzio C, Vitarelli A, Carmignani L. Contemporary urethral stricture characteristics in the developed world. Urology. 2013;81(1):191. DOI: https://doi.org/10.1016/j.urology.2012.08.062

Lumen N, Piet H, Pieter W, De Troyer B, Ronny P, Willem O. Etiology of urethral stricture disease in the 21st century. J Urol. 2009;182(3):983. DOI: https://doi.org/10.1016/j.juro.2009.05.023

Heyns C, van der Merwe J, Basson J, van der Merwe A. Etiology of male urethral strictures-Evaluation of temporal changes at a single center, and review of the literature. Afr J Urol. 2012;18(1):4. DOI: https://doi.org/10.1016/j.afju.2012.04.009

Cotter KJ, Amy EH, Bryan BV, Jeremy BM, Thomas GS, Sean PE, et al. Trends in Urethral Stricture Disease Etiology and Urethroplasty Technique From a Multi-institutional Surgical Outcomes Research Group. Urology. 2019;130:167. DOI: https://doi.org/10.1016/j.urology.2019.01.046

Fenton AS, Morey AF, Aviles R, Garcia CR. Anterior urethral strictures: etiology and characteristics. Urology. 2005;65(6):1055. DOI: https://doi.org/10.1016/j.urology.2004.12.018

Depasquala I, Park AJ, Bracka A. The treatment of balanitis xerotica obliterans. BJU Int. 2000;86(4):459. DOI: https://doi.org/10.1046/j.1464-410X.2000.00772.x

Filipas D, Fisch M, Fichtner J, Fitzpatrick J, Berg K, Störkel S. The histology and immunohistochemistry of free buccal mucosa and full-skin grafts after exposure to urine. BJU Int. 1999;84(1):108-11. DOI: https://doi.org/10.1046/j.1464-410x.1999.00079.x

Brandes SB, Smith J, Virgo K, Johnson FE. Adult t anterior urethral strictures: a national practice patterns survey. J Urol. 2001;165:13.

Peterson AC, Webster GD. Management of urethral stricture disease: developing options for surgical intervention. BJU Int. 2004;94(7):971-6. DOI: https://doi.org/10.1111/j.1464-410X.2004.05088.x

Barbagli G, Palminteri E, Lazzeri M, Guazzoni G. Anterior urethral strictures. BJU Int. 2003;92(5):497-505. DOI: https://doi.org/10.1046/j.1464-410X.2003.04379.x

Humby G. A one-stage operation for hypospadius repair. Br J Surg. 1941;29:84-92. DOI: https://doi.org/10.1002/bjs.18002911312

Bhargava S, Chapple CR. Buccal mucosal urethroplasty: Is it the new gold standard? BJU Int. 2004;93(9):1191-3. DOI: https://doi.org/10.1111/j.1464-410X.2003.04860.x

Singh GP, Mishra GK. Dorsal Versus Ventral OnlayBuccal Mucosal Graft Urethroplasty in Bulbar Urethral Stricture Disease: A Prospective Randomized Study. Ann Int Med Den Res. 2020;6(4):SG33-7.

Katiyar VK, Sood R, Sharma U, Goel HK, Gahlawat S, Desai DS. Critical Analysis of Outcome Between Ventral and Dorsal Onlay Urethroplasty In Female Urethral Stricture. Urology. 2021;157:79-84. DOI: https://doi.org/10.1016/j.urology.2021.05.021

Shekhar IC, Manikanthan J, Raju AA, Samantharay PR. A comparative study of dorsal versus ventral onlay buccal mucosal graft urethroplasty for long segment bulbar urethral stricture.Int J Acad Med Pharm. 2023;5(4):447-51.

Vasudeva P, Nanda B, Kumar A, Kumar N, Singh H, Kumar R. Dorsal versus ventral onlay buccal mucosal graft urethroplasty for long-segment bulbar urethral stricture: A prospective randomized study. Int J Urol. 2015;22(10):967-71. DOI: https://doi.org/10.1111/iju.12859