Objectives: To evaluate the efficacy of one-stage buccal mucosal tubed graft in long and repeated urethroplasty.
Methods: Thirty-four patients with long and repeated strictures of the urethra underwent buccal mucosal urethroplasty from 2000 to 2003. For all patients, one-stage buccal mucosal tubed graft urethroplasty was performed by releasing and extracting the fibrous tissue around the stricture, harvesting buccal mucosa from the inner cheek, tubing the graft, and interposing it in the defect. The urethral catheter was removed 3 weeks postoperatively. Suprapubic drainage was in place until urethral patency was confirmed by antegrade cystourethrography. The patients were followed up with clinical history and symptom reporting, urinalysis and culture, periodic uroflowmetry, ultrasonography, and cystourethrography at 1, 3, and 6 months and yearly thereafter. The urinary flow rates before and after surgery, postvoid residual urine volumes, restricture rates, and incidence of incontinence, erectile dysfunction, fistula, and diverticulum were assessed.
Results: The procedure was technically successful in all patients. The mean operative time was 150 minutes. During 28 months (range 12 to 39) of follow-up, the success rate was 76.5%. Restricture occurred in 5 patients during the first year postoperatively. Urethrocutaneous fistula, erectile dysfunction, and diverticulum occurred in 2, 1, and 1 patient, respectively. The mean urinary flow rate and postvoid residual urine volume improved significantly. Patient satisfaction was good.
Conclusions: Buccal mucosal grafts are tough, resilient, easy to harvest, and leave no scar. They appear to be an optimal substitute for anterior and posterior long urethral strictures in repeated urethroplasty.