COMBINED INLAY AND ONLAY BUCCAL MUCOSA URETHROPLASTY FOR LONG AND NARROW BULBAR URETHRAL STRICTURES

DR. GAUTAM BANGARECONSTRUCTIVE UROLOGISTCENTRE FOR URETHRA AND PENILE SURGERY (UPS)NEW DELHI, INDIA

SHORT SEGMENT STRICTURE -6 FR URETROSCOPE CAN BE NEGOTIATED –SINGLE SIDE BUCCAL MUCOSA IS SUFFICIENT.

BUT WHAT TO DO ABOUT STRICTURE WHICH DOES NOT EVEN HAVE A CALIBRE OF 6FR

INTRODUCTION: Long segment urethral strictures with a very

narrow lumen pose an immense challenges for buccal mucosa augmentation urethroplasty.

Larger discrepancy in size of the graft and the native urethral plate makes it difficult to place the sutures and also makes the graft vulnerable to contracture and fibrosis.

Increasing the width of the urethral plate by a vertical midline mucosal incision and applying an additional inlay buccal mucosal graft may lessen the discrepancy and help in improving the adequacy of the urethral lumen.

INTRODUCTION Other option to deal with these kind of

strictures is dorsal onlay and ventral inlay. Spongiofibrosis is never full thickness except

in traumatic injury ( straddle injury/blunt trauma)

Partial thickness Spongiofibrosis and scarred mucosa can be removed completely and replaced by buccal mucosa.

SURGICAL TECHNIQUE: Lithotomy position Epidural + general anesthesia. Vertical perineal incision. Mobilization of

bulbar urethra Dorsal ( one side kulkarni’s technique)or

ventral urethrotomy Vertical midline incision or complete removal

of scarred urethral plate with removal of thin layer of spongiofibrosis.

Inlay and onlay grafting done Urethra closed over 16 fr

DISPARITY BETWEEN URETHRAL PLATE AND BUCCAL MUCOSA

SCARRED URETHRAL PLATE AND THIN LAYER OF SPONGIOFIBROSIS REMOVED

INLAY-ONLAY UNIFORMITY

RESULTS:

Results were analysed on the basis of pre and post operative uroflowmetry.

Any kind of instrumentation was considered as failure.

Mean follow up 630 days. 22 patients have significant better flow rate

after surgery One patient developed ring stricture near

proximal anastomosis and managed by urethral dilatation.

One patient developed abscess followed by urine leak and was managed conservatively with indwelling catheter and antibiotics.

CONCLUSION Combined urethroplasty avoid complete

transection of urethra. It widens the native urethral plate in an

anatomical manner Reduces the disparity between urethral plate

and onlay buccal mucosa. improves the success rate of long and very

narrow bulbar urethra strictures][