Reconstructive UrologyLong-term Outcomes of Urethroplasty With Abdominal Wall Skin Grafts
Section snippets
Methods
We performed an institutional review board–approved retrospective study of 291 patients who underwent urethroplasty at a single institution between 2000 and 2010 with at least 1 year of documented follow-up. Patients with incomplete operative or outcomes data, or lack of assessment of voiding symptoms at least 1 year postoperatively were excluded from analysis. The final study cohort included 238 patients. Patient data were retrospectively gathered from electronic medical records. Demographic
Results
A total of 238 men with an average age of 42.9 years (range, 15-79 years) underwent urethroplasty for urethral stricture with a mean length of 5.6 cm (range, 1-24 cm), and a median follow-up of 59.3 months (range, 12.5-147 months). The urethral stricture locations are described in Table 1. A total of 58.4% patients had undergone prior intervention for stricture (ie, dilation, internal urethrotomy, and urethroplasty), of which 15 patients (6.3%) had failed prior urethroplasty, and 41 patients
Comment
Buccal mucosa harvest is the most common graft tissue used for urethral reconstruction but may be limited in the amount of graft tissue available for extensive strictures.6 Barbagli et al9 reported a maximum graft area of 4 cm in length and 2.5 cm in width from each cheek to minimize complications. Reported complications from oral mucosa harvest include pain, perioral numbness, tightness of the mouth, motor deficits, and long-term speech morbidity (lingual mucosa grafts exceeding 7 cm).7 The
Conclusion
AWS grafts are an alternative graft source for men with extensive or recurrent urethral stricture, with advantages of a large continuous area of graft, limited donor site morbidity, extragenital origin of the skin, and avoidance of extensive oral mucosal harvest. Although AWS graft remains an option in these patients, it may be associated with a higher recurrence risk than other types of repair. However, these data may be reflective of the patient cohort requiring AWS, with this population
References (15)
- et al.
Combined buccal mucosa graft and genital skin flap for reconstruction of extensive anterior urethral strictures
Urology
(2006) - et al.
Postauricular skin as an alternative to oral mucosa for anterior onlay graft urethroplasty: a preliminary experience in patients with oral mucosa changes
Urology
(2009) - et al.
Urethral reconstruction using colonic mucosa graft for complex strictures
J Urol
(2009) - et al.
Urethroplasty with abdominal skin grafts for long segment urethral strictures
J Urol
(2010) - et al.
Morbidity of oral mucosa graft harvesting from a single cheek
Eur Urol
(2010) - et al.
Long-term follow-up and deterioration rate of anterior substitution urethroplasty
J Urol
(2014) - et al.
Long-term efficacy of distal penile circular fasciocutaneous flaps for single stage reconstruction of complex anterior urethral stricture disease
J Urol
(2008)
Cited by (22)
Oral adverse outcomes associated with the buccal mucosa graft for urethroplasty
2022, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologySurgical Approaches and Long-Term Outcomes in Adults with Complex Reoperative Hypospadias Repair
2018, Journal of UrologyCitation Excerpt :All 4 patients in whom stricture recurred had a skin graft. A study by Liu et al from our institution provided long-term outcomes of urethroplasty with abdominal wall skin grafts.11 Univariate analysis demonstrated that abdominal wall skin grafts were associated with recurrent stricture but this did not hold on multivariate analysis.
Natural History of Low-stage Urethral Strictures
2017, UrologyUse of a fibrovascular tube in creation of neo-urethra during penile reconstruction
2017, Journal of Pediatric UrologyCitation Excerpt :Buccal mucosa grafts have important rates of fistula formation, stricture, and meatal stenosis, [26]. Skin grafts tend to contract and have poor elasticity, incompatible with erectile function, and also carry the risk of a hairy urethra, even if harvested from an apparently non-hairy area [27,28]. The vein can be used either directly or after evertion inside-out as a substitute for urethral reconstruction [29], but the existence of the valve inside the venous lumen and donor site morbidity may have a negative effect for urethral reconstruction using vein grafts.
Financial Disclosure: The authors declare that they have no relevant financial interests.