Average followup was 71 months (range 41 to 110). Clinical outcome was considered a failure when postoperative instrumentation was needed, including dilation. Of 45 cases 33 (73 % ) were classified as successful and 12 (27 % ) were failures. The 12 failures were treated with internal urethrotomy (1), end-to-end-anastomosis (1), skin graft urethroplasty (2) and 2-stage urethroplasty (6). Six of the 12 initial failures had a satisfactory final outcome. The remaining 6 patients refused further surgical procedures and received a definitive perineal urethrostomy.
Penile skin grafts used as a dorsal onlay for bulbar urethral reconstruction in a homogeneous series of patients showed a tendency to deteriorate with time. Longer followup is required to compare penile skin with buccal mucosa as substitute materials for bulbar urethral reconstruction.
DORSAL ONLAY GRAFT URETHROPLASTY FOR REPAIR OF BULBAR U... The Journal of Urology |
65340bcbaf34165b03"">DORSAL ONLAY GRAFT URETHROPLASTY FOR REPAIR OF BULBAR URETHRAL STRICTURE The Journal of Urology, Volume 161, Issue 3, March 1999, Pages 815-818 CHRISTOPHE E. ISELIN, GEORGE D. WEBSTER Abstract PurposeWe report the early outcome of dorsal full-thickness penile skin grafts in the repair of bulbar urethral stricture.Materials and MethodsDuring 27 months 29 men with a mean age of 43 years (range 10 to 81) underwent dorsal onlay graft urethroplasty. Followup included retrograde urethrogram at 3 weeks, 3 months and 12 to 18 months, and thereafter when needed. Urinary flow was recorded as subjectively reported by the patients. ResultsThe technique was used only for bulbar urethral strictures. A total of 23 patients (79 % ) had undergone previous direct vision urethrotomy and/or open surgery. Dorsal onlay graft urethroplasty was used alone in 12 patients (41 % ), and was performed with partial stricture excision and ventral strip anastomosis in 13 (45 % ). In another 4 patients (14 % ) the procedure was combined with an Orandi flap because the stricture extended significantly into the penile urethra. Penile skin grafts were used in 27 patients (93 % ), whereas buccal mucosa was harvested in 2. Mean graft length was 6 cm. (range 3 to 9), and width ranged between 1.5 and 3 cm. Outcome was favorable in 28 patients (97 % ) for a median followup of 19 months (range 10 to 37). One patient had symptomatic proximal stricture recurrence and 3 had radiographic evidence of caliber decrease of the repair but with no impact on urinary flow. ConclusionsDorsal onlay graft urethroplasty is a versatile procedure which maybe combined with stricture excision and ventral strip anastomosis or an Orandi flap. Conceptually the technique offers the advantages of spread fixation of the graft on a fixed well vascularized surface, which may improve graft neovascularization, reduce graft shrinkage and avoid sacculation. Although the early outcome is promising, dorsal onlay graft urethroplasty has yet to stand the test of time. Purchase PDF (675 K) |
ANASTOMOTIC URETHROPLASTY AND DORSAL ONLAY GRAFT URETHR... The Journal of Urology |
ANASTOMOTIC URETHROPLASTY AND DORSAL ONLAY GRAFT URETHROPLASTY FOR URETHRAL STRICTURES: IMPACT OF PREVIOUS URETHRAL MANIPULATION ON THE FINAL OUTCOME The Journal of Urology, Volume 179, Issue 4, Supplement 1, April 2008, Page 19 Murat Tunc, Oner Sanli, Omer Acar, Murat Atar, Cavit Ozsoy, Tarik Esen, Necdet Aras Purchase PDF (121 K) |
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