Anastomotic Fibrous Ring As Cause Of Stricture Recurrence After Bulbar Onlay Graft Urethroplasty ~ 2010-01-30

UroToday.com - Buccal mucosa graft onlay urethroplasty represents one of the most widespread methods for repairing strictures in the bulbar urethra. Achievement rates induce been high with dorsal or ventral grafts because of the bulbar urethra’s thick and hugely vascular spongiosal chain. Stricture recurrence can arise despite adequate surgical technique however.

In a recent review by Guido Barbagli and colleagues from Italy, stricture recurrence after onlay urethroplasty with buccal mucosa grafts in the bulbar urethra is reviewed. The study in published in the August 2006 climax of the Log of Urology.

Constraint recurrence after bulbar substitution urethroplasty using strip or buccal grafts has 2 features, namely substantial fibrous tissue involving the in general grafted area or a short fibrous ring restraint at the distal or proximal anastomotic sites. The authors investigated the prevalence, locale and possible etiology of postoperative anastomotic ring strictures affecting 3 types of bulbar urethroplasty at the orientation where the join was sutured to the apex of the urethral serving.

A gross of 107 consecutive patients with an customarily age of 44 years underwent bulbar substitution urethral reconstruction between 1994 and 2004. Ordinary stricture for ages c in depth was 4 cm, and a totality of 102 patients underwent an ordinarily of 2.5 prior urethrotomies or dilations (range 1 to 11) before open patch up. Forty-five patients had dorsally placed free skin grafts placed and 50 patients underwent a number of buccal mucosa urethroplasties (17 ventral, 27 dorsal and 6 lateral). Generally follow-up in the series was 74 months.

Analysis of the results showed that 85 cases (80%) were considered successes and 22 cases (20%) were considered failures. The 45 dorsal onlay pelt transplant urethroplasties provides successes in 33 cases (73%) and dead duck in 12 (27%). The 50 buccal grafts provided success in 42 cases (84%) and failure in 8 (16%).

In 12 group 1 cases (55%) the 22 failures involved the whole grafted area. These patients were when all is said treated with perineal urethrotomies. In 10 organize 2 cases (45%), the failures involved the anastomotic sites (5 distal and 5 proximal). These were the so-called “fibrous ring” strictures. The fibrous ring stricture thus had an occurrence of 9% in the entire group. The etiology of such strictures is unrecognized at this time. Feasible etiologies of distal incompetent include a less stout urethral spongiosum as we go unconscious distally and understaging may contribute to proximal anastomotic failures.

By Michael J. Metro, MD

J Urol. 2006 Aug; 176(2):614-19

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