Dorsal Onlay  Urethroplasty Using Buccal Mucosa graft or  Penile Skin Flap for Management of Long Anterior Urethral Strictures: A Prospective Randomized Study

Samir El Gamal1, Hussein Abdel Hameed2, Mohamed Abo Farha1 and Mohamed Gaber1
Urology Department, Tanta University, Tanta, Egypt1
Urology Department, Fayoum University, Fayoum, Egypt2.

Objective:
The aim of this randomized study is  to compare the outcomes of  dorsal onlay urethroplasty using  buccal mucosa graft or penile skin flap in the repair of long anterior urethral strictures.
 
Patients and Methods:
In this prospective study 37 patients with anterior urethral strictures were randomized to undergo buccal mucosa dorsal onlay (19) or penile skin flap (18) urethroplasty. Operative time, hospital stay, short and long-term complications, recurrence rates, and patient satisfaction were compared between the 2 groups.

Results:

The number of patients with pendulous, bulbar and bulbopendulous strictures as well as mean stricture length and mean follow-up were comparable between the 2 groups.  Mean operative time was significantly higher in the penile flap vs. the buccal mucosa graft group. In the penile flap group 3 patients had superficial penile skin necrosis, 1 had extensive skin loss and required skin grafting, and 2 had penile torsion.  In the buccal mucosa group  6 patients had minor oral morbidity  in the form of perioral numbness and increased salivation which settled by 4 weeks after surgery. Troublesome post-voiding dribbling was significantly more in  penile flap group than in buccal mucosa graft group. In the buccal mucosa group 84.2% and in the penile flap group 66.7% said they would recommend this procedure to another patient (p = 0.001).  The success rate in the buccal mucosa (89.5%) and penile flap (83.3%) groups was similar (p > 0.05).

Conclusions:

Dorsal onlay buccal mucosa graft and  penile skin flap urethroplasty provide similar
success rates. Compared to buccal mucosa, penile flap procedures are technically complex, associated with higher morbidity and less preferred by patients.

 
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