Combined dorsal plus ventral double buccal mucosa graft in bulbar urethral reconstruction

This is a retrospective study of the use and efficacy of combined dorsal and ventral double buccal mucosal graft (BMG) in bulbar urethral reconstruction. A total of 48 males, of mean age 35 years, underwent this procedure from March 2002 to June 2006. The stenotic urethral segment was opened ventrally and dorsal urethra was incised in midline to create an elliptical area over the tunica albuginea. Fibrotic tissue was partially excised from urethral margins taking care to preserve the urethral plate. Dorsal inlay BMG (av. length 2.36 cm) was placed and quilted. Subsequently ventral onlay BMG (av. length 4.68 cm) was sutured to the urethral lateral margins and spongioplasty was performed. The average stricture length was 3.65 (2-10) cm and mean follow-up was 22 (13-59) months. The technique was successful (normal voiding without any need of postoperative procedures) in 43 (89.6%) patients. Of the five (10.4%) failures recurrences developed within 12 months after surgery and were mainly at proximal or distal anastomotic sites. VIU was successful in four while one patient needed perineal urethrostomy. The authors concluded that combined double patch of buccal mucosa was much better in patients having tight strictures with very narrow and scarred urethral plate. This technique provides wider neourethra than a single patch graft substitution.