Combining ventral buccal mucosal graft onlay and dorsal full thickness skin graft inlay decreases failure rates in long bulbar strictures (≥6 cm)

Urology. 2013 Apr;81(4):899-902. doi: 10.1016/j.urology.2012.11.055. Epub 2013 Mar 7.


Objective: To evaluate the efficacy of augmenting ventral onlay buccal urethroplasty using a using a double-sided graft technique by adding a second, full-thickness skin graft (FTSG) dorsally in long strictures ≥4 cm, we hypothesized that a double-sided graft technique would improve surgical outcomes over buccal mucosal graft (BMG) ventral onlay urethroplasty alone.

Methods: Retrospective chart review was performed comparing 15 patients who had undergone double-sided BMG + FTSG urethroplasty for long strictures ≥4 cm to a cohort group of 115 patients who had undergone BMG onlay urethroplasty for strictures of similar length. Comparisons of age, stricture lengths, time-to-failure, follow-up intervals, and failure rates were analyzed. Further analysis included age and stricture length matched control comparisons between BMG + FTSG patients to BMG only patients.

Results: Mean patient age, stricture length, and time to stricture recurrence were 44 years, 5.1 cm, and 10 months, respectively, in the BMG group. For the BMG + FTSG group, mean age was 52 years, stricture length 5.9 cm, and time to recurrence was 9 months. Overall, the BMG group had a decreased failure rate; 17% compared to 21%. Further analysis showed BMG ventral onlay had decreased failure rates for strictures <6 cm; 16% compared to 33%. However, for strictures ≥6 cm, the BMG + FTSG had a 0% failure rate compared to 24% in the BMG ventral onlay group (P = .005).

Conclusion: Combined BMG and FTSG urethroplasty for very long bulbar urethral strictures ≥6 cm improve success rates compared to using BMG urethroplasty alone.

MeSH terms

  • Adult
  • Humans
  • Male
  • Mouth Mucosa / transplantation*
  • Retrospective Studies
  • Skin Transplantation*
  • Transplantation, Autologous
  • Urethral Stricture / surgery*