Ventral Buccal Mucosa Graft Urethroplasty with Gracilis Muscle Flap for High Risk, Long Segment Urethral Strictures: A 20-Year Experience.

OBJECTIVE

To evaluate our 20-year experience of urethroplasty with ventral buccal mucosa graft (BMG) and gracilis muscle flap coverage for long segment urethral strictures unfit for standard repair due to a compromised graft bed and poor vascular supply.

METHODS

We retrospectively reviewed the records of 1687 patients who underwent urethroplasty at our institution between 1999 and 2019. We identified 30 patients who underwent urethroplasty with a ventral BMG and gracilis muscle flap graft bed. Stricture recurrence was defined as the inability to pass a 17-French cystoscope.

RESULTS

Mean stricture length was 7.6 centimeters (range 3.5-15). Strictures were located in the posterior urethra with or without involvement of the bulbar urethra in 60% of cases, the bulbomembranous urethra in 30%, the bulbar urethra in 6.7%, and the proximal pendulous urethra in 3.3%. Stricture etiology was radiation therapy in 60% of cases, prostatectomy in 23.3%, transurethral surgery in 13.3%, idiopathic in 13.3%, trauma in 10%, and hypospadias failure in 3.3%. Ten (33.3%) patients were previously treated with urethroplasty, 26 (86.7%) had prior endoscopic stricture management, and 3 (10%) previously underwent UroLume stent placement. Urethral reconstruction was successful in 23 cases (76.7%) at a mean follow-up of 32 months (range 4-92). Two of the patients in whom treatment failed underwent urinary diversion, 3 underwent suprapubic tube placement, 1 had endoscopic urethral dilation, and 1 had direct visual internal urethrotomy performed. Mean time to recurrence was 8 months (range 2-17). Postoperatively, 7 patients (23.3%) had incontinence requiring artificial urinary sphincter placement.

CONCLUSION

Ventral BMG urethroplasty with gracilis muscle flap coverage can be successfully performed for high risk, long segment urethral strictures, avoiding urinary diversion in most patients.