Single Stage Buccal Graft Urethroplasty for Long Segment Anterior Urethral Strictures: Experience and Outcome From a Tertiary Hospital.

Abstract

Background: Urethral stricture is one of the common urologic diseases constituting significant workload to urology practice worldwide. The prevalence is estimated to be 229–627 per 100,000 malesand its effects on the quality of life of those with the disease are enormous. Successful treatment of urethral stricture has been a challenge to urologists particularly long segment and complex strictures. This led to several procedures to evolve over past several decades. Substitution urethroplasty has become the gold standard procedure for the treatment of long segment anterior urethral strictures. Objective: To document the experience and outcome of use of single stage buccal graft urethroplasty for treatment of long segment anterior urethral stricture in a tertiary hospital. Patients and Method : It was a retrospective descriptive study of all patients who were treated for long segment anterior urethral stricture by single stage buccal graft substitution urethroplasty in our hospital from 2016 to 2021(5years). Medical records of patients were retrieved and their information about bio-data, presentation, risk factors for urethral stricture, investigations done. The type of buccal graft harvest and onlay and outcome including complications were extracted and entered into the already designed proforma. The generated data was entered into excel sheets and analyzed using special package for social sciences (SPSS) and results presented in tables and figures. Results: A total of 45 patients were treated for long segment anterior urethral stricture by single stage buccal graft substitution urethroplasty between 2016 and 2021(5years) of which the records of 42 patients were retrieved and data was collected and analyzed. All were males within the age range of 35 to 78 years and a mean age of 57.2years ±7.4SD. The risk factors for urethral stricture were past history of purulent urethritis (59.5%), prolong catheterization (21.5%), urethral trauma (9.5%), past urethral surgery (9.5%). The site of the urethral stricture was found as follows; Penile urethra (61.9%), Penobulbar (26.2%), Bulbar urethra (7.1%) and Panurethra (4.8%). Intra operative length of the stricture was found as follows: <5cm (21.4%), 5-10cm (23.8%), 10 -15cm (50%) and >15cm (4.8%). The buccal graft onnlay procedures used were dorsolateral onlay (73.8%), dorsal onlay (14.3%), ventral onlay (11.9%). Following urethroplasty catheter was removed as follows: <4weeks (42.9%), 4-6weeks (38.1%) and >6weeks (19%). Complications recorded were: Surgical site infection (21.4%), urethral diverticulum (4.8%), urethrocutaneous fistula (2.4%) and recurrence (4.8%). Majority of the patients (66.7%) had no complication. Conclusion: Single stage buccal graft substitution urethroplasty for long segment anterior urethral stricture has overall good success rate with minimal complications.