Versatility of the ventral approach in bulbar urethroplasty using dorsal, ventral or dorsal plus ventral oral grafts

Enzo Palminteri; Elisa Berdondini; Ferdinando Fusco; Cosimo De Nunzio; Kostas Giannitsas; Ahmed A Shokeir

doi:10.1016/j.aju.2012.02.009

Versatility of the ventral approach in bulbar urethroplasty using dorsal, ventral or dorsal plus ventral oral grafts

Arab J Urol. 2012 Jun;10(2):118-24. doi: 10.1016/j.aju.2012.02.009. Epub 2012 Apr 20.

Authors

Enzo Palminteri¹, Elisa Berdondini¹, Ferdinando Fusco², Cosimo De Nunzio³, Kostas Giannitsas⁴, Ahmed A Shokeir⁵

Affiliations

¹ Center for Urethral and Genitalia Reconstructive Surgery, Arezzo, Italy.
² Department of Urology, University Federico II, Naples, Italy.
³ Department of Urology, Sant'Andrea Hospital, 'La Sapienza' University, Rome, Italy.
⁴ Urology Department, Patras University Hospital, Patras, Greece.
⁵ Urology & Nephrology Center, Mansoura, Egypt.

Abstract

Objectives: To investigate the versatility of the ventral urethrotomy approach in bulbar reconstruction with buccal mucosa (BM) grafts placed on the dorsal, ventral or dorsal plus ventral urethral surface.

Patients and methods: Between 1999 and 2008, 216 patients with bulbar strictures underwent BM graft urethroplasty using the ventral-sagittal urethrotomy approach. Of these patients, 32 (14.8%; mean stricture 3.2 cm, range 1.5-5) had a dorsal graft urethroplasty (DGU), 121 (56%; mean stricture 3.7, range 1.5-8) a ventral graft urethroplasty (VGU), and 63 (29.2%; mean stricture 3.4, range 1.5-10) a dorsal plus ventral graft urethroplasty (DVGU). The strictured urethra was opened by a ventral-sagittal urethrotomy and BM graft was inserted dorsally or ventrally or dorsal plus ventral to augment the urethral plate.

Results: The median follow-up was 37 months. The overall 5-year actuarial success rate was 91.4%. The 5-year actuarial success rates were 87.8%, 95.5% and 86.3% for the DGU, VGU and DVGU, respectively. There were no statistically significant differences among the three groups. Success rates decreased significantly only with a stricture length of >4 cm.

Conclusions: In BM graft bulbar urethroplasties the ventral urethrotomy access is simple and versatile, allowing an intraoperative choice of dorsal, ventral or combined dorsal and ventral grafting, with comparable success rates.

Keywords: (D)(V)(DV)GU, (dorsal) (ventral) (dorsal plus ventral) graft urethroplasty; AU, anastomotic urethroplasty; BM, buccal mucosa; Buccal mucosa; Graft; Stricture; Urethra; Urethroplasty; VCUG, voiding cysto-urethrography.